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Singing, video games, yard work, writing, books, crafting, outdoor activities, and spending time with her son.
Education Status: General Educational Development (GED) Obtained
Area of Study: Biology, Wildlife and Fisheries Biology
Vision: Excellent, does not wear lenses
Hearing: Good
Dentition: Excellent, no orthodontia required
Allergies: None known
Hospitalization: 1990s, 2010s
Alcohol Usage: Does not drink alcohol
Tobacco Usage: Does not smoke
Drug Usage: Tests NEGATIVE for Drugs of Abuse.
Paternal Grandfather: Died in his 50's, Cirrhosis of the liver in his 50's
Paternal Grandmother: Alive and in her 70's, Healthy
Maternal Grandfather: Died in his 50's, Malignant brain tumor in his 50's, passed away due to complications associated with radiation treatment
Maternal Grandmother: Alive and in her 70's, Healthy
Father: Died in his 40's, Passed away due to injuries resulting from a fall
Mother: Alive and in her 40's, Healthy
Siblings: At least one, all in good health.
Genetic Screening Performed: Yes
Donor Communication (Type): Open
Limited Available? No
Past Pregnancy: No
Face: Round in shape with average forehead set and light acne on her forehead, cheeks and chin
Lips: Full upper and lower lips
Nose: Wide shape, average in length, with a rounded tip
Ears: Medium in size, tucked back,attached lobes
Eyes: Almond shape, small size, average set
Eyebrows: Medium fullness, straight
Summary: She has a "take charge" presence about her. It is obvious she is intelligent and driven.
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | |||
Maternal Uncle 2: | |||
Maternal Uncle 3: | |||
Paternal Aunt 1: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||
Maternal Uncle 2: | ||
Maternal Uncle 3: | ||
Paternal Aunt 1: | ||
Paternal Uncle 1: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Maternal Cousin 3: | ||
Maternal Cousin 4: | ||
Maternal Cousin 5: | ||
Maternal Cousin 6: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: | ||
Paternal Cousin 3: | ||
Paternal Cousin 4: | ||
Paternal Cousin 5: | ||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | |||
Maternal Uncle 2: | |||
Maternal Uncle 3: | |||
Paternal Aunt 1: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | 30's | |||
Maternal Cousin 3: | 40's | |||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | |||
Maternal Uncle 2: | |||
Maternal Uncle 3: | |||
Paternal Aunt 1: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | |||
Maternal Uncle 2: | |||
Maternal Uncle 3: | |||
Paternal Aunt 1: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | |||
Maternal Uncle 2: | |||
Maternal Uncle 3: | |||
Paternal Aunt 1: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: |
Relative | Migraines (age of onset) |
Mental Retardation (age of onset) |
Alzheimers (age of onset) |
Multiple Sclerosis (age of onset) |
---|---|---|---|---|
Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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 Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
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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Paternal Aunt 1: |
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Maternal Cousin 1: |
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Maternal Cousin 2: |
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Relative | Myasthenia Gravis (age of onset) |
Other Muscle/Bone/Joint Disorder (age of onset & disorder) |
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Self | ||
Mother | ||
Father | ||
Brother 1: | ||
Brother 2: | ||
Maternal Grandmother | ||
Maternal Grandfather | ||
Paternal Grandmother | ||
Paternal Grandfather | ||
Maternal Uncle 1: | ||
Maternal Uncle 2: | ||
Maternal Uncle 3: | ||
Paternal Aunt 1: | ||
Paternal Uncle 1: | ||
Maternal Cousin 1: | ||
Maternal Cousin 2: | ||
Maternal Cousin 3: | ||
Maternal Cousin 4: | ||
Maternal Cousin 5: | ||
Maternal Cousin 6: | ||
Paternal Cousin 1: | ||
Paternal Cousin 2: | ||
Paternal Cousin 3: | ||
Paternal Cousin 4: | ||
Paternal Cousin 5: | ||
Paternal Cousin 6: |
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) |
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Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
Relative | Color Blindness (age of onset) |
Glaucoma (age of onset) |
Deviated Septum (age of onset) |
Sinusitis (age of onset) |
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Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |
Relative | Other Sight/Hearing/Olfactory Disorder (age of onset & disorder) |
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Self | |
Mother | |
Father | |
Brother 1: | |
Brother 2: | |
Maternal Grandmother | |
Maternal Grandfather | |
Paternal Grandmother | |
Paternal Grandfather | |
Maternal Uncle 1: | |
Maternal Uncle 2: | |
Maternal Uncle 3: | |
Paternal Aunt 1: | |
Paternal Uncle 1: | |
Maternal Cousin 1: | |
Maternal Cousin 2: | |
Maternal Cousin 3: | |
Maternal Cousin 4: | |
Maternal Cousin 5: | |
Maternal Cousin 6: | |
Paternal Cousin 1: | |
Paternal Cousin 2: | |
Paternal Cousin 3: | |
Paternal Cousin 4: | |
Paternal Cousin 5: | |
Paternal Cousin 6: |
Relative | Alcoholism (age of onset) |
Drug Abuse or Addiction (age of onset) |
Smoker/Tobacco Use (age of onset) |
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Self | |||
Mother | |||
Father | |||
Brother 1: | |||
Brother 2: | |||
Maternal Grandmother | |||
Maternal Grandfather | |||
Paternal Grandmother | |||
Paternal Grandfather | |||
Maternal Uncle 1: | |||
Maternal Uncle 2: | |||
Maternal Uncle 3: | |||
Paternal Aunt 1: | |||
Paternal Uncle 1: | |||
Maternal Cousin 1: | |||
Maternal Cousin 2: | |||
Maternal Cousin 3: | |||
Maternal Cousin 4: | |||
Maternal Cousin 5: | |||
Maternal Cousin 6: | |||
Paternal Cousin 1: | |||
Paternal Cousin 2: | |||
Paternal Cousin 3: | |||
Paternal Cousin 4: | |||
Paternal Cousin 5: | |||
Paternal Cousin 6: |
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) |
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Self | ||||
Mother | ||||
Father | ||||
Brother 1: | ||||
Brother 2: | ||||
Maternal Grandmother | ||||
Maternal Grandfather | ||||
Paternal Grandmother | ||||
Paternal Grandfather | ||||
Maternal Uncle 1: | ||||
Maternal Uncle 2: | ||||
Maternal Uncle 3: | ||||
Paternal Aunt 1: | ||||
Paternal Uncle 1: | ||||
Maternal Cousin 1: | ||||
Maternal Cousin 2: | ||||
Maternal Cousin 3: | ||||
Maternal Cousin 4: | ||||
Maternal Cousin 5: | ||||
Maternal Cousin 6: | ||||
Paternal Cousin 1: | ||||
Paternal Cousin 2: | ||||
Paternal Cousin 3: | ||||
Paternal Cousin 4: | ||||
Paternal Cousin 5: | ||||
Paternal Cousin 6: |