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Swimming, boating, fishing, camping, snow skiing, snowmobiling, drawing, painting, making pottery and keeping up with her son.
Education Status: High School Diploma Obtained
Area of Study: Nursing
Vision: Excellent, does not wear lenses
Hearing: Excellent
Dentition: Good, orthodontia required
Allergies: None known
Hospitalization: None known
Alcohol Usage: Does drink alcohol; 0-3 Drinks per week
Tobacco Usage: Does not smoke
Drug Usage: Tests NEGATIVE for Drugs of Abuse.
Paternal Grandfather: Alive and in his 70's, Prostate cancer in his 70s
Paternal Grandmother: Alive and in her 70's, Healthy
Maternal Grandfather: Alive and in his 70's, Prostate cancer in his 70s
Maternal Grandmother: Alive and in her 70's, Healthy
Father: Died in his 30's, Died in a hunting accident
Mother: Alive and in her 50's, Healthy, occasional migraine headache
Siblings: At least one sibling, all in good health
Genetic Screening Performed: Yes
Donor Communication (Type): Open
Limited Available? No
Past Pregnancy: No
Face: Tapered oval shape with high cheekbones
Lips: Medium fullness to upper and lower lips
Nose: Slightly larger than normal, average shape and straight profile
Ears: Average size, tucked back, attached lobes
Eyes: Almond shape, straight on face, slightly smaller than average, deep set
Eyebrows: Medium fullness, curved
Summary: She is such a sweet girl, a bit shy when you first meet her with a smile to warm your heart. She is a hard worker, often working overtime to help at work. She will no doubt make a great nurse someday!
Have you or any member of your family (by blood), had a problem or defect at birth of any of the following body systems?
Relative | Problem at birth: Bones, muscles, joints, limbs |
Problem at birth: Gastrointestinal system |
Problem at birth: Nervous system, brain, spinal cord |
Problem at birth: Blood circulatory system |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Have you or any member of your family (by blood), had a problem or defect at birth of any of the following body systems?
Relative | Problem at birth: Breathing, respiratory system |
Problem at birth: Heart |
Problem at birth: Other organs |
Problem at birth: Genital, urinary, reproductive |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Have you or any member of your family (by blood), had a problem or defect at birth of any of the following body systems?
Relative | Problem at birth: Metabolic |
Problem at birth: Learning disabilities |
Problem at birth: Other |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Brother 1: | |||
Brother 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Paternal Uncle 1: | |||
Paternal Uncle 2: | |||
Paternal Uncle 3: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: | |||
Paternal Cousin 7: | |||
Paternal Cousin 8: | |||
Paternal Cousin 9: | |||
Paternal Cousin 10: | |||
Paternal Cousin 11: | |||
Paternal Cousin 12: | |||
Paternal Cousin 13: | |||
Paternal Cousin 14: |
Relative | Heart Attack (age of onset) |
Heart Disease (age of onset) |
High Blood Pressure (age of onset) |
Arrhythmia (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Stroke (age of onset) |
TIA (Mini Stroke) (age of onset) |
Aneurism (age of onset) |
Other Heart/Vascular Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Anemia (age of onset) |
Sickle Cell (age of onset) |
Hemophilia (age of onset) |
Leukemia (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Immune Problems (age of onset) |
Other Blood Disorder (age of onset & disorder) |
---|---|---|
Self | ||
Mother | ||
Father | ||
Brother 1: | ||
Brother 2: | ||
Maternal Grandmother | ||
Maternal Grandfather | ||
Paternal Grandmother | ||
Paternal Grandfather | ||
Maternal Aunt 1: | ||
Maternal Aunt 2: | ||
Maternal Aunt 3: | ||
Paternal Aunt 1: | ||
Paternal Aunt 2: | ||
Paternal Uncle 1: | ||
Paternal Uncle 2: | ||
Paternal Uncle 3: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Maternal Cousin 3: | ||
Maternal Cousin 4: | ||
Maternal Cousin 5: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: | ||
Paternal Cousin 3: | ||
Paternal Cousin 4: | ||
Paternal Cousin 5: | ||
Paternal Cousin 6: | ||
Paternal Cousin 7: | ||
Paternal Cousin 8: | ||
Paternal Cousin 9: | ||
Paternal Cousin 10: | ||
Paternal Cousin 11: | ||
Paternal Cousin 12: | ||
Paternal Cousin 13: | ||
Paternal Cousin 14: |
Relative | Hay Fever (age of onset) |
Asthma (age of onset) |
Emphysema (age of onset) |
Tuberculosis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Lung Cancer (age of onset) |
Pneumonia (age of onset) |
Other Respiratory Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Brother 1: | |||
Brother 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Paternal Uncle 1: | |||
Paternal Uncle 2: | |||
Paternal Uncle 3: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: | |||
Paternal Cousin 7: | |||
Paternal Cousin 8: | |||
Paternal Cousin 9: | |||
Paternal Cousin 10: | |||
Paternal Cousin 11: | |||
Paternal Cousin 12: | |||
Paternal Cousin 13: | |||
Paternal Cousin 14: |
Relative | Ulcers (age of onset) |
Gall Stones (age of onset) |
Hepatitis A (age of onset) |
Hepatitis B (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Other Liver Disease (age of onset) |
Colon Cancer (age of onset) |
Ulcerative Colitis (age of onset) |
Crohn's Disease (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Cystic Fibrosis (age of onset) |
Intestinal Cancer (age of onset) |
Other Gastro-Intestinal Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Brother 1: | |||
Brother 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Paternal Uncle 1: | |||
Paternal Uncle 2: | |||
Paternal Uncle 3: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: | |||
Paternal Cousin 7: | |||
Paternal Cousin 8: | |||
Paternal Cousin 9: | |||
Paternal Cousin 10: | |||
Paternal Cousin 11: | |||
Paternal Cousin 12: | |||
Paternal Cousin 13: | |||
Paternal Cousin 14: |
Relative | Diabetes (age of onset) |
Hypoglycemia (age of onset) |
Thyroid Cancer (age of onset) |
Thyroid Disease (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Goiter (age of onset) |
Adrenal Disorder (age of onset) |
Hyperactivity (age of onset) |
Other Metabolic/Endocrine Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Kidney Disease (age of onset) |
Disease of Ureter, Bladder, Urethra (age of onset) |
Rectal Disorder (age of onset) |
Other Urinary Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Undescended Testicle(s) (age of onset) |
Hypospadiasis (age of onset) |
HPV/Genital Warts (age of onset) |
Genital Herpes (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Prostate Cancer (age of onset) |
Uterine Fibroids (age of onset) |
Ovarian Cysts (age of onset) |
Cancer of the Cervix (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | 70's | |||
Paternal Grandmother | ||||
Paternal Grandfather | 70's | |||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Cancer of the Uterus (age of onset) |
Varicocele | Other Genital/Reproductive Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Brother 1: | |||
Brother 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Paternal Uncle 1: | |||
Paternal Uncle 2: | |||
Paternal Uncle 3: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: | |||
Paternal Cousin 7: | |||
Paternal Cousin 8: | |||
Paternal Cousin 9: | |||
Paternal Cousin 10: | |||
Paternal Cousin 11: | |||
Paternal Cousin 12: | |||
Paternal Cousin 13: | |||
Paternal Cousin 14: |
Relative | Acne (age of onset) |
Scarring Acne (age of onset) |
Eczema (age of onset) |
Psoriasis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Skin Cancer (age of onset) |
Pigmentation Disorders (age of onset) |
Other Skin Disorder (age of onset & disorder) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Brother 1: | |||
Brother 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Paternal Uncle 1: | |||
Paternal Uncle 2: | |||
Paternal Uncle 3: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: | |||
Paternal Cousin 7: | |||
Paternal Cousin 8: | |||
Paternal Cousin 9: | |||
Paternal Cousin 10: | |||
Paternal Cousin 11: | |||
Paternal Cousin 12: | |||
Paternal Cousin 13: | |||
Paternal Cousin 14: |
Relative | Migraines (age of onset) |
Mental Retardation (age of onset) |
Alzheimers (age of onset) |
Multiple Sclerosis (age of onset) |
---|---|---|---|---|
Self | Teens | |||
Mother | Teens | |||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Cerebral Palsey (age of onset) |
Epilepsy (age of onset) |
Hydrocephalus (age of onset) |
Spinal Cord Disorder (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Huntington's Chorea (age of onset) |
Gaucher's Disease (age of onset) |
Wilson's Disease (age of onset) |
Other Neurological Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Schizophrenia (age of onset) |
Manic Depression (age of onset) |
Clinical Depression (age of onset) |
Other Mental Health Disorder (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Muscular Dystrophy (age of onset) |
Other Chronic Muscle Disease (age of onset & disorder) |
Lupus (age of onset) |
Deformity of Spine (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Osteoporosis (age of onset) |
Dwarfism (age of onset) |
Arthritis (age of onset) |
Gout (age of onset) |
---|---|---|---|---|
Self |
|
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Mother |
|
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Father |
|
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Brother 1: |
|
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Brother 2: |
|
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Maternal Grandmother |
|
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Maternal Grandfather |
|
|||
Paternal Grandmother |
|
|||
Paternal Grandfather |
|
|||
Maternal Aunt 1: |
|
|||
Maternal Aunt 2: |
|
|||
Maternal Aunt 3: |
|
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Paternal Aunt 1: |
|
|||
Paternal Aunt 2: |
|
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Paternal Uncle 1: |
|
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Paternal Uncle 2: |
|
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Paternal Uncle 3: |
|
|||
Maternal Cousin 1: |
|
|||
Maternal Cousin 2: |
|
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Maternal Cousin 3: |
|
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Maternal Cousin 4: |
|
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Maternal Cousin 5: |
|
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Paternal Cousin 1: |
|
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Paternal Cousin 2: |
|
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Paternal Cousin 3: |
|
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Paternal Cousin 4: |
|
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Paternal Cousin 5: |
|
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Paternal Cousin 6: |
|
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Paternal Cousin 7: |
|
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Paternal Cousin 8: |
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Paternal Cousin 9: |
|
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Paternal Cousin 10: |
|
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Paternal Cousin 11: |
|
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Paternal Cousin 12: |
|
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Paternal Cousin 13: |
|
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Paternal Cousin 14: |
|
Relative | Myasthenia Gravis (age of onset) |
Other Muscle/Bone/Joint Disorder (age of onset & disorder) |
---|---|---|
Self | ||
Mother | ||
Father | ||
Brother 1: | ||
Brother 2: | ||
Maternal Grandmother | ||
Maternal Grandfather | ||
Paternal Grandmother | ||
Paternal Grandfather | ||
Maternal Aunt 1: | ||
Maternal Aunt 2: | ||
Maternal Aunt 3: | ||
Paternal Aunt 1: | ||
Paternal Aunt 2: | ||
Paternal Uncle 1: | ||
Paternal Uncle 2: | ||
Paternal Uncle 3: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Maternal Cousin 3: | ||
Maternal Cousin 4: | ||
Maternal Cousin 5: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: | ||
Paternal Cousin 3: | ||
Paternal Cousin 4: | ||
Paternal Cousin 5: | ||
Paternal Cousin 6: | ||
Paternal Cousin 7: | ||
Paternal Cousin 8: | ||
Paternal Cousin 9: | ||
Paternal Cousin 10: | ||
Paternal Cousin 11: | ||
Paternal Cousin 12: | ||
Paternal Cousin 13: | ||
Paternal Cousin 14: |
Relative | Deafness before age 60 (age of onset) |
Deformity of the Ear (age of onset) |
Cataracts before age 50 (age of onset) |
Blindness (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Color Blindness (age of onset) |
Glaucoma (age of onset) |
Deviated Septum (age of onset) |
Sinusitis (age of onset) |
---|---|---|---|---|
Self | Teens | |||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |
Relative | Other Sight/Hearing/Olfactory Disorder (age of onset & disorder) |
---|---|
Self | |
Mother | |
Father | |
Brother 1: | |
Brother 2: | |
Maternal Grandmother | |
Maternal Grandfather | |
Paternal Grandmother | |
Paternal Grandfather | |
Maternal Aunt 1: | |
Maternal Aunt 2: | |
Maternal Aunt 3: | |
Paternal Aunt 1: | |
Paternal Aunt 2: | |
Paternal Uncle 1: | |
Paternal Uncle 2: | |
Paternal Uncle 3: | |
Maternal Cousin 1: | |
Maternal Cousin 2: | |
Maternal Cousin 3: | |
Maternal Cousin 4: | |
Maternal Cousin 5: | |
Paternal Cousin 1: | |
Paternal Cousin 2: | |
Paternal Cousin 3: | |
Paternal Cousin 4: | |
Paternal Cousin 5: | |
Paternal Cousin 6: | |
Paternal Cousin 7: | |
Paternal Cousin 8: | |
Paternal Cousin 9: | |
Paternal Cousin 10: | |
Paternal Cousin 11: | |
Paternal Cousin 12: | |
Paternal Cousin 13: | |
Paternal Cousin 14: |
Relative | Alcoholism (age of onset) |
Drug Abuse or Addiction (age of onset) |
Smoker/Tobacco Use (age of onset) |
---|---|---|---|
Self | |||
Mother | |||
Father | |||
Brother 1: | |||
Brother 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Aunt 1: | |||
Maternal Aunt 2: | |||
Maternal Aunt 3: | |||
Paternal Aunt 1: | |||
Paternal Aunt 2: | |||
Paternal Uncle 1: | |||
Paternal Uncle 2: | |||
Paternal Uncle 3: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: | |||
Paternal Cousin 7: | |||
Paternal Cousin 8: | |||
Paternal Cousin 9: | |||
Paternal Cousin 10: | |||
Paternal Cousin 11: | |||
Paternal Cousin 12: | |||
Paternal Cousin 13: | |||
Paternal Cousin 14: |
Relative | Oral Herpes/Cold Sores (age of onset) |
Other Disorder (age of onset & disorder) |
Breast Cancer (age of onset) |
Any Other Cancer (age of onset & disorder) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Aunt 1: | ||||
Maternal Aunt 2: | ||||
Maternal Aunt 3: | ||||
Paternal Aunt 1: | ||||
Paternal Aunt 2: | ||||
Paternal Uncle 1: | ||||
Paternal Uncle 2: | ||||
Paternal Uncle 3: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: | ||||
Paternal Cousin 7: | ||||
Paternal Cousin 8: | ||||
Paternal Cousin 9: | ||||
Paternal Cousin 10: | ||||
Paternal Cousin 11: | ||||
Paternal Cousin 12: | ||||
Paternal Cousin 13: | ||||
Paternal Cousin 14: |