Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'0"
(182 cm) |
Weight:
155 lb
(70 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Straight |
Skin Tone:
Medium Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
Irish/Dutch-English-German
|
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Education:
BS Kinesiology/Sports Mgmt
|
Occupation:
Customer Service
|
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Interests:
|
Gardening, Individual Sports, Outdoor Activities, Painting, Team Sports
|
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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 | 65 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
63
Medication
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 36 |
| 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
Situational depression
19
Therapy and medication, resolved
Your Mother's Father
| Question | Response |
| Current age or age at death | 84 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Dementia
83
Medication and nursing care
Your Mother's Mother
| Question | Response |
| Current age or age at death | 39 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Coronary heart disease |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart Disease
39
None
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 | 63 |
| 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 | 68 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Unknown - estranged |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Unknown
Estranged from family
Your Father's Father
| Question | Response |
| Current age or age at death | 96 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart failure, assisted care |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
96
Assisted care
Your Father's Mother
| Question | Response |
| Current age or age at death | 76 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Ovarian cancer
65
Chemotherapy and radiation
Your Father's Sisters 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 Sisters 2
| 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 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 | 63 |
| 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 | 61 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | Christian |
| Denomination | Non-denominational |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | N/A |