Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'4"
(193 cm) |
Weight:
190 lb
(86 kg) |
Eye Color:
Blue
|
Hair:
Blond/
Straight |
Skin Tone:
Medium Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A-
|
Ethnic Background:
English-German/Italian-Polish
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Education:
BBA/Marketing, Sup. Chn. Mgmt.
|
Occupation:
Entrepreneur
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Interests:
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Jazz music, Paddle boarding, Skateboarding, Sports, Surfing, Woodworking, Working out
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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? | No |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | No |
| CMV IgG Antibody | Positive |
| CMV IgM Antibody | Negative |
| Note any comments regarding above items: | N/A |
Family Medical HistorySee list of questions asked here
Your Mother
| Question | Response |
| Current age or age at death | 59 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father
| Question | Response |
| Current age or age at death | 62 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 29 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Father
| Question | Response |
| Current age or age at death | 72 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Cirrhosis of the liver |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Cirrhosis of the liver (drinker, but not an alcoholic)
70
Palliative care only
Your Mother's Mother
| Question | Response |
| Current age or age at death | 87 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 1
| Question | Response |
| Current age or age at death | 68 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 2
| Question | Response |
| Current age or age at death | 58 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Lung cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer (smoker)
56
Chemotherapy
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 56 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Father
| Question | Response |
| Current age or age at death | 79 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Lung cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer (smoker)
77
Chemotherapy
Your Father's Mother
| Question | Response |
| Current age or age at death | 84 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 59 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Brothers 1
| Question | Response |
| Current age or age at death | 56 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Lung cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
54
Chemotherapy
Your Father's Brothers 2
| Question | Response |
| Current age or age at death | 55 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | None |
| Denomination | Raised Christian, but I'm not religious |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | N/A |