Family History


Family MemberOccupation
Level of Schooling
MotherHomemaker

High School
FatherSmall Business Owner

High School




Family MemberAge if LivingAge at DeathCause of Death
Mother50


Father55


Maternal Grandmother70


Maternal Grandfather75


Paternal Grandmother
80
Old Age
Paternal Grandfather
55
Accident
Sisters


Brothers21


Donor & Family Health History

Medical ProblemDonorFamily
HeartNoneNone
BloodNoneNone
RespiratoryNoneNone
Gastrointestinal
NoneNone
Metabolic/Endocrine
NoneNone
UrinaryNoneNone
Genital / ReproductiveNoneNone
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNoneNone
SkinAcne
Mother and Brother - Acne
OtherNone
None

Identification #RR364


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1978
Place of BirthIndia
Height5'11"
Weight160
Eye Color
Brown
ComplexionMedium, Asian
HairBlack, straightRight Handed      X
Left Handed
Religion Born IntoHindu
Married   No
HeritageIndian

Occupation Graduate Student in Marine Engineering

Years of College  8
Interests Tennis and jogging



Notes Standard and Prewashed vials available.



Test Results
Test Results
Blood TypeA+
HIV 1/2 Ab & HIV 1 Ag
Nonreactive
ChlamydiaNegative
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
Negative
CMV ScreenPositive
SGPT
Within normal limits
CMV, IgM/Culture
Negative
Sickle cell
Not applicable
Cystic FibrosisNoncarrier of 51 Common Mutations
Syphilis, antibody MHA-TP
Nonreactive
HbsAg
Nonreactive
Tay Sachs & Canavan
Not applicable
HbcAb
Nonreactive
Hepatitis C, Ab
Nonreactive
Thalassemia
Normal adult hemoglobin
HCVRNA/HIV-1 RNA
Nonreactive/Nonreactive
Notes