Donor Number 949

General Information

Donor Code:
949
Ethnic Origin:
English, French, German, Irish, Scotch-Irish
Blood Type:
A Positive
Hair Color:
Red
Type of Hair:
Wavy
Thickness of Hair:
Thick
Age at Time of Retrieval:
25
Eye Color:
Hazel
Complexion Relative to Race:
Fair
Bone Structure:
Petite
Height:
5'4"
Weight:
121
Handedness:
Left-Handed

She loves music and theater. She plays three instruments and loves good games of pool. She enjoys family, hiking, bike riding. Books are a passion of hers. She states, "I'll never say no to basking in the sunshine."

Education Status: High School Diploma Obtained

Area of Study: Anthropology, Nursing

Vision: Fair, does wear lenses

Hearing: Excellent

Dentition: Excellent, no orthodontia required

Allergies: Sulfa

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, Mini stroke in his 70's.

Paternal Grandmother: Alive and in her 80's, Healthy.

Maternal Grandfather: Alive and in his 70's, Glaucoma in his 30's, due to traumatic head injury.

Maternal Grandmother: Alive and in her 70's, Healthy.

Father: Alive and in his 60's, Asthma in his 20's, COPD in his 40's, smoker.

Mother: Alive and in her 50's, Asthma in her 40's, exercised induced, possibly from second hand smoke.

Siblings: At least one, all in good health.

Genetic Screening Performed: Yes

This donor has been screened for 107 genetic diseases (via targeted mutation analysis) and has been found to test positive for the following:

MTHFR Deficiency

All people carry mutations for genetic disorders. Genetic testing can identify some of those mutations. We perform testing for a large number of conditions that are inherited in a recessive manner to help detect some of the mutations in our donors. Since all people carry mutations, donors are not excluded from our program when these mutations are identified. The donors' offspring are not at risk to develop the condition unless the other biological parent also carrier a mutation for the same inherited disorder. We encourage you to use the results of the donor's testing and consider your own genetic testing to help identify a donor suitable for your needs.

ORIGINAL FAMILY HEALTH HISTORY:

The donor's personal and family health history was originally reported on 2/24/2016.

UPDATED HEALTH HISTORY:

No new information reported at this time.

Donor Communication (Type): Open

Limited Available? Fewer than 6 eggs available

Past Pregnancy: No

Face: Face shape is round, average in size, with an average to high forehead. She has many "sun-kissed" very light freckles, sprinkled across her face. No cleft in her chin or dimples.

Lips: Lips are medium in fullness, both upper and lower.

Nose: Small and straight, with a straight profile. It is average in length and width, with a small nostril flare.

Ears: Medium in size, with attached lobes, close in distance to face.

Eyes: Medium in size, almond in shape. They have an average setting, with medium length lashes.

Eyebrows: Medium thickness and angled in direction.

Summary: This donor is so intuitive and so smart! You can really tell that she is a nurse- trustworthy, honest and dependable. She impressed the staff with her great manners and her accountability. She has great features, beautiful auburn/red hair and a perfect nose. She is overall, a very lovely girl with a very intelligent disposition.

 

Childhood Photos

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Medical History

Medical History: Birth Defects/Congenital Problems

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
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Paternal Cousin 36:

Medical History: Birth Defects/Congenital Problems (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
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Paternal Cousin 36:

Medical History: Birth Defects/Congenital Problems (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
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Medical History: Heart/Vascular

Relative Heart Attack
(age of onset)
Heart Disease
(age of onset)
High Blood Pressure
(age of onset)
Arrhythmia
(age of onset)
Self
Mother
Father 50's
Brother 1:
Brother 2:
Maternal Grandmother
Maternal Grandfather
Paternal Grandmother
Paternal Grandfather
Maternal Aunt 1:
Maternal Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
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Paternal Cousin 1:
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Medical History: Heart/Vascular (cont.)

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 70's
Maternal Aunt 1:
Maternal Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
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Medical History: Blood

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
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Medical History: Blood (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
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Paternal Cousin 1:
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Medical History: Respiratory

Relative Hay Fever
(age of onset)
Asthma
(age of onset)
Emphysema
(age of onset)
Tuberculosis
(age of onset)
Self
Mother 40's
Father Pre-Teens Teens
Brother 1:
Brother 2:
Maternal Grandmother
Maternal Grandfather
Paternal Grandmother
Paternal Grandfather
Maternal Aunt 1:
Maternal Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
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Maternal Cousin 12:
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Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
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Maternal Cousin 21:
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Paternal Cousin 1:
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Medical History: Respiratory (cont.)

Relative Lung Cancer
(age of onset)
Pneumonia
(age of onset)
Other Respiratory Disorder
(age of onset & disorder)
Self
Mother
Father 40's COPD
Brother 1:
Brother 2:
Maternal Grandmother
Maternal Grandfather
Paternal Grandmother
Paternal Grandfather
Maternal Aunt 1:
Maternal Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
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Maternal Cousin 16:
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Maternal Cousin 19:
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Paternal Cousin 1:
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Medical History: Gastro-Intestinal

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
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Paternal Cousin 1:
Paternal Cousin 2:
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Paternal Cousin 36:

Medical History: Gastro-Intestinal (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
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Paternal Cousin 1:
Paternal Cousin 2:
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Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Gastro-Intestinal (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Metabolic/Endocrine

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Metabolic/Endocrine (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Urinary

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Genital/Reproductive

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Genital/Reproductive (cont.)

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 Aunt 1:
Maternal Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Genital/Reproductive (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Skin

Relative Acne
(age of onset)
Scarring Acne
(age of onset)
Eczema
(age of onset)
Psoriasis
(age of onset)
Self
Mother
Father
Brother 1: Teens
Brother 2:
Maternal Grandmother
Maternal Grandfather
Paternal Grandmother
Paternal Grandfather
Maternal Aunt 1:
Maternal Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Skin (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Neurological

Relative Migraines
(age of onset)
Mental Retardation
(age of onset)
Alzheimers
(age of onset)
Multiple Sclerosis
(age of onset)
Self 20's
Mother
Father
Brother 1:
Brother 2:
Maternal Grandmother
Maternal Grandfather
Paternal Grandmother
Paternal Grandfather
Maternal Aunt 1:
Maternal Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
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:
Paternal Cousin 15:
Paternal Cousin 16:
Paternal Cousin 17:
Paternal Cousin 18:
Paternal Cousin 19:
Paternal Cousin 20:
Paternal Cousin 21:
Paternal Cousin 22:
Paternal Cousin 23:
Paternal Cousin 24:
Paternal Cousin 25:
Paternal Cousin 26:
Paternal Cousin 27:
Paternal Cousin 28:
Paternal Cousin 29:
Paternal Cousin 30:
Paternal Cousin 31:
Paternal Cousin 32:
Paternal Cousin 33:
Paternal Cousin 34:
Paternal Cousin 35:
Paternal Cousin 36:

Medical History: Neurological (cont.)

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 Uncle 1:
Maternal Uncle 2:
Paternal Uncle 1:
Paternal Uncle 2:
Paternal Uncle 3:
Paternal Uncle 4:
Maternal Cousin 1:
Maternal Cousin 2:
Maternal Cousin 3:
Maternal Cousin 4:
Maternal Cousin 5:
Maternal Cousin 6:
Maternal Cousin 7:
Maternal Cousin 8:
Maternal Cousin 9:
Maternal Cousin 10:
Maternal Cousin 11:
Maternal Cousin 12:
Maternal Cousin 13:
Maternal Cousin 14:
Maternal Cousin 15:
Maternal Cousin 16:
Maternal Cousin 17:
Maternal Cousin 18:
Maternal Cousin 19:
Maternal Cousin 20:
Maternal Cousin 21:
Maternal Cousin 22:
Paternal Cousin 1:
Paternal Cousin 2:
Paternal Cousin 3: