Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
5'9"
(175 cm) |
Weight:
165 lb
(74 kg) |
Eye Color:
Blue
|
Hair:
Brown/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
English-Irish-Scottish/Irish-Italian
|
||||
|
Education:
DPT/Physical Therapy
|
Occupation:
Lab Assistant, Student
|
||||
|
Interests:
|
Anything athletic, Outdoors, Reading, Spending time with friends and family
|
||||
Medical
| Question | Response |
| Have you or any of your family members been diagnosed with alcoholism or drug addiction? If yes, relation and age affected: | No |
| Any dietary restrictions? If yes, explain: | No |
| Do you wear glasses or contact lenses? Are you near or far-sighted? | Yes - Near-sighted |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | No |
| CMV IgG Antibody | Negative |
| CMV IgM Antibody | Negative |
| Note any comments regarding above items: | N/A |
Family Medical HistorySee list of questions asked here
Your Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 58 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 54 | |
| Health Problem | Asthma, since childhood, mild, no treatment necessary | |
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 29 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Brother 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 28 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Sisters
Your Sister 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 24 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Heart attack (smoker/drinker), fatal, no treatment | 60 |
| Cause of death: Heart attack | 60 | |
| Living / Dead | Dead |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 70 | |
| Health Problem | Ovarian cancer, no treatment | 70 |
| Cause of death: Ovarian cancer | 70 | |
| Living / Dead | Dead |
Your Mother's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 45 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 52 | |
| Health Problem | Healthy | |
| Cause of death: Homicide | 52 | |
| Living / Dead | Dead |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 66 | |
| Health Problem | Heart attack (smoker), fatal, no treatment | 66 |
| Cause of death: Heart attack | 66 | |
| Living / Dead | Dead |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 75 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 58 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 55 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 46 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Religion:
| Faith | None |
| Denomination | N/A |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | N/A |