Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'0"
(182 cm) |
Weight:
169 lb
(76 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Wavy |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
Scandinavian/Dutch-Puerto Rican
|
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Education:
Pursing BS/Aerospace Eng
|
Occupation:
Avionics Technician
|
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Interests:
|
Guitar, Skateboard, Snowboard, Sports, Surf
|
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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 | 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 |
| Current age or age at death | 63 |
| 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 | 78 |
| 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 | 53 - Paternal half brother |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Sisters
Your Sister 1
| Question | Response |
| Current age or age at death | 53 - Paternal half sister |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Multiple sclerosis
48
Medication
Your Sister 2
| 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 | 88 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Prostate cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Prostate cancer
70
Unknown
Your Mother's Mother
| Question | Response |
| Current age or age at death | 97 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart failure |
Health Problems
Healthy
Your Mother's Sisters 1
| Question | Response |
| Current age or age at death | 65 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 67 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 2
| Question | Response |
| Current age or age at death | 64 |
| 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 | 72 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Accidental |
Health Problems
Healthy
Your Father's Mother
| Question | Response |
| Current age or age at death | 82 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Complications of sinus infection |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Sinus infection
82
N/A
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 63 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 2
| Question | Response |
| Current age or age at death | 61 |
| 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 | 70 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Brothers 2
| Question | Response |
| Current age or age at death | 18 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Trauma |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Trauma due to car accident
18
N/A
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 |