Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'1"
(185 cm) |
Weight:
192 lb
(87 kg) |
Eye Color:
Blue
|
Hair:
Brown/
Wavy |
Skin Tone:
Medium
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
German/German-Polish
|
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Education:
MSN/Family Nurse Practitioner
|
Occupation:
Registered Nurse
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Interests:
|
Photography, Running, Volleyball
|
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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? | Yes - Near-sighted, started wearing at age 18 |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | Yes - Cats, age 12 (runny nose and itchy eyes); Seasonal allergies, age 17. Both treated with over the counter medication |
| 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 | 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 | 65 |
| 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 | 40 - 1/2 Paternal |
| 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 | 34 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Seasonal allergies
15
Over the counter medication
Cat allergies
15
Over the counter medication
Your Sister 2
| Question | Response |
| Current age or age at death | 32 |
| 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 | 81 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
81
None; passed away in sleep
Your Mother's Mother
| Question | Response |
| Current age or age at death | 86 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural, dementia related |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Dementia
80
Medication controlled
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 Sisters 2
| 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
Your Mother's Brothers 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 Father's Father
| Question | Response |
| Current age or age at death | 65 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Car accident |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Car accident
65
No treatment, immediately fatal
Your Father's Mother
| Question | Response |
| Current age or age at death | 87 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Respiratory failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Respiratory failure
87
None
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 66 |
| 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 | 63 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 3
| Question | Response |
| Current age or age at death | 58 |
| 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 | 67 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Pacemaker
60
NA
Heart transplant
65
NA
Your Father's Brothers 2
| 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
Religion:
| Faith | Christian |
| Denomination | Lutheran |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | Update recevied September 2020: Donor's Maternal grandfather was diagnosed with macular degeneration in his 60's, eventually resulting in blindness. This grandfather passed away at age 81 of heart failuer, as mentioned in the family history. |