EXPANDED PROFILE : Eve675

Transcription

1 EPANDED PROFILE : Eve675

2 SOME INTERESTING FACTS ABOUT: YOUR STAR SIGN: WHAT DO YOU CONSIDER AS YOUR BEST FACIAL FEATURE: WHAT DO YOU CONSIDER TO BE YOUR BEST PHYSICAL FEATURE: HOW WOULD YOU DESCRIBE YOUR SMILE: HOW WOULD YOU DESCRIBE YOUR LAUGH: WHICH ACTRESS OR FAMOUS PERSON YOU THINK YOU RESEMBLE: Eve675 Cancer My eyes/mouth My breast/ butt/ calves Open & friendly Contagious (funny and loud) Marika Dominczyk FAVOURITES FOOD/S: BOOK/S: MOVIE/S: SONG/S: DO YOU PLAY A MUSICAL INSTRUMENT? FAVOURITE MUSICAL INSTRUMENT: ACTOR/ESS: COLOUR: CAR: FLOWER: GEM STONE: ANIMAL: TIME OF DAY: SEASON: DESTINATION: HISTORICAL FIGURE: PERSON YOU WOULD MOST LIKE TO MEET: WHY? FAVOURITE SCHOOL: ANY SPECIAL AWARDS/ACHIEVEMENTS: FAVOURITE QUOTE: Cooked meats and lots of veggies Inkheart Trilogy & Twilight Saga Twilight and Transformers (action/drama/epic/sci-fi, fantasy genres) Hardstyle, rock, metal and trance No Guitar Kristen Stewart, Robert Pattinson, Robert Downey Jr and Gerard Butler Blues, greens and black Camero, Chevrolet (muscle cars) Rose Ruby Cats and dogs (and anything saveable) (but not flies, ticks, cockroaches or mosquitoes!) Afternoons (sunset) All seasons (mostly winter) Scotland/Ireland Artists (Michael Angelo, Da Vinci, Van Gogh, S. Dali) Robert Downey Jr He is an actor s actor. He got over his drug addiction and is truly a great inspiration as well as a good person and super talented actor. Art and Design My degree (B Tech) and I bought my own car on my own Motivation does not last long, neither does bathing, that is why we recommend it daily. PERSONAL PREFERENCES/ABILITIES ARE YOU SKILLED: HOW WOULD YOU RATE YOUR ABILITY IN MATH: LITERARY SKILLS: SCIENTIFIC/ RESEARCH ABILITIES: ARTICTIC TALENTS: MUSIC SKILLS / ABILITIES: ATHLETIC ABILITIES: HOW MANY LANGUAGES CAN YOU SPEAK? MECHANICALLY / TECHNICALLY 2: English and Afrikaans

3 SPECIAL SKILLS & PERSONALITY OF FAMILY MEMBERS Music / Artistic / Athletic / Scientific / Math skills / Personality / Employment / Hobbies / Other interesting facts MOTHER: My mother is caring and loving and is a great cook. She is very athletic and gyms a lot while still being quite artistic, although she did not pursue it. She is great with Math. She is funny when she chooses to be! She enjoys cooking, reading, baking and loves animals. FATHER: I do not know much about him as I did not grow up with him. However, I know that he loves having fun, motor sports and cares about his family. He is very adventurous. ½ SISTER 1: She is funny and is the family s clown. She is the glue that keeps us together. She is my best friend and I can always lean on her for support. ½ SISTER 2: I do not know anything about her. ½ BROTHER: I do not know anything about him. DONORS HANDWRITING SAMPLE KEIRSEY TEMPERAMENT: GUARDIAN Guardians are the cornerstone of society, for they are the temperament given to serving and preserving our most important social institutions. Guardians have natural talent in managing goods and services--from supervision to maintenance and supply -- and they use all their skills to keep things running smoothly in their families, communities, schools, churches, hospitals, and businesses. All Guardians share the following core characteristics: Guardians pride themselves on being dependable, helpful, and hard-working. Guardians make loyal mates, responsible parents, and stabilizing leaders. Guardians tend to be dutiful, cautious, humble, and focused on credentials and traditions. Guardians are concerned citizens who trust authority, join groups, seek security, prize gratitude, and dream of meting out justice. Guardians can have a lot of fun with their friends, but they are quite serious about their duties and responsibilities. Guardians take pride in being dependable and trustworthy; if there's a job to be done, they can be counted on to put their shoulder to the wheel. Guardians also believe in law and order and sometimes worry that respect for authority even a fundamental sense of right and wrong, is being lost. Perhaps this is why Guardians honour customs and traditions so strongly -- they are familiar patterns that help bring stability to our modern, fast-paced world. Practical and down-to-earth, Guardians believe in following the rules and cooperating with others. They are not very comfortable winging it or blazing new trails; working steadily within the system is the Guardian way, for in the long run loyalty, discipline, and teamwork get the job done right. Guardians are meticulous about schedules and have a sharp eye for proper procedures. They are cautious about change, even though they know that change can be healthy for an institution. Better to go slowly, they say, and look before you leap. Guardians make up as much as 40 to 45 percent of the population, and a good thing, because they usually end up doing all the indispensable but thankless jobs the rest of the population takes for granted. Guardian Portraits: Mother Teresa, William Howard Taft, Harry S. Truman, George Washington

4 FACIAL CHARACTERISTICS Face Shape: Square Eye Shape: Hooded / Down Turned / Almond / Round / Protruding Eye Set: Narrow / Close / Average / Deep/ Wide Eye Size: Small / Average / Large Eye colour: Green Lip Shape: Full / Thin / Flat upper Lip / Perfect / Large top lip / Droopy shape Nose Shapes: Wavy / Snub / Flat / Aquiline / Upturned / Straight/Narrow Hair Line: Straight / Round / Widow s Peak Hair form: Wavy / Slightly Curly / Straight / Ethnic Hair Texture: Average / Thick / Fine / Coarse / Thin Hair Colour: Honey Brown Premature Graying: Yes / No If yes, at what age: N/A Present hair loss: None / Thinning Complexion: Peaches & Cream Tan Ability: None / Slight / Medium / Easy Cheek Bones: High / Low / Wide / Flat / Pointed Facial Features: Moles / Freckles / Dimples / Beauty Spots / Cleft Chin / Gap tooth /Overbite/ None PHYSICAL CHARACTERISTICS Body Shape: Full Hour Glass Height: 1.58m Weight: 66.0kg BMI: 26.4 Build: Petite/Small/Medium/Athletic/Large/Stocky Hands: Right-handed/Left-handed/Ambidextrous

5 MEDICAL PROFILE PERSONAL HEALTH HISTORY Blood Group (ABO): Unknown Are you adopted? No Rhesus: Unknown Are either of your parents adopted? No Vision (without corrective lenses): Poor / Fair / Good / Excellent Do you wear corrective lenses? Yes If yes, for what problem(s)? Farsighted / Short-sighted / Other: Explain: Use mainly to work on a computer and for night driving. Hearing (without corrective aids): Poor / Fair / Good / Excellent Do you wear corrective aids? No If yes, for what problems? N/A Do you smoke cigarettes? No If yes, how many per day? N/A Do you drink alcohol? Yes If yes, how often? Moderate, on weekends I drink half a glass of wine Diet: Vegetarian / Non vegetarian / Other: Allergies: Yes If yes, are they to: Food(s) /Medication(s) /Cosmetics / Environmental / Animals / Insects For each allergy, describe specific substance and reaction(s) and age first noticed: Substance: Pollen Reaction(s): Sneezing Age: 7 Explain allergies you have outgrown: Exercise/ Sporting activities: None / Occasional / Regular Type of Exercise: Weight training/ cardio Have you had any surgery (ies)? No If yes please explain: Have you had any hospitalisation(s) not mentioned above? No Have you had a blood transfusion? No Are you a blood donor? No Have you ever been excluded from blood donation for reason of infectious disease? No Have you had major radiation or x-ray exposure? No If yes, explain: Have you had any psychological or psychiatric care? No If yes, explain: Are you currently taking any medications, prescribed or over the counter? Yes If yes, please list: Allergex Are you currently using any recreational drugs? Yes If yes, please list: Smokes marijuana twice per month Do you have any physical deformities for which you have sought surgical corrections? No If so, please explain: N/A

6 Have you ever been tested as a carrier of? Carrier Non-carrier Unknown Tay-Sach s disease Sickle Cell disease Thalassemia Cystic Fibrosis FERTILITY HISTORY AMH: Not tested AFC: Measured Have you ever been pregnant? No Do you have any children? No If yes, please complete sex : N/A Any special comments concerning your children? N/A Are you currently on any form of birth control? Yes Do you have a regular period? Yes Is there any history of fertility problems in your family (difficulty conceiving or miscarriages)? PSYCHOLOGICAL ASSESSMENT All our donors undergo psychological screening prior to their first donation. This assessment and subsequent assessments are valid for one year. SEUAL HEALTH HISTORY Have you or any of your sexual partner been in contact with anyone or have personally been treated for any of the following: NO TO ALL Self Partner When HIV NSU (non specific urethritis) Syphilis Gonorrhea Chlamydia Venereal Warts Herpes Viral Hepatitis B or C Hemophilia Received human-derived clotting factor concentrates IV (intravenous) drug use Other sexually transmitted diseases Do you practice safe sex at all times? Yes Do you consider your sexual practices risky for HIV infection? No Have you or any of your sexual partners: -engaged in sexual relations with a partner of the same sex during the last 5 years? No -had sex in exchange for money or drugs in the preceding 5 years? No -within the past 12 months undergone tattooing, acupuncture, ear or body piercing? Yes, October 2016

7 FAMILY BIO/HISTORY Year of Birth Health Status Age at time of Death Cause of Death Eye Colour Mother Green Brown Olive Athletic Hair Colour Complexion Height (m) Weight (kg) Build Father Green Blond Light +/ / Short/ Sturdy ½ Brother Green Blond Short/ Stocky ½ Sisters Green Green Sandy Blond Dark Blond Olive Medium Athletic Plump Child MGM Green Brown Olive Athletic MGF Blue Golden/ Brown Fair Athletic PGM Green Brown Olive PGF s Unknown/ Organ failure Blue - Medium Tall (MGM = Maternal Grandmother, MGF = Maternal Grandfather, PGM = Paternal Grandmother, PGF = Paternal Grandfather, - = Unknown) How many blood siblings are in your immediate family (including yourself)? 1 Number of Males: Number of Females: 1 How many half siblings are in your immediate family? 3 If so, from which parent? Mother and Father Number of Males: 1 Number of Females: 2 How many adopted siblings are in your immediate family (including yourself)? 0 Number of Males: - Number of Females: - Are there any twins or triplets in your family? No If yes, what relations are they to you? N/A Are there any known genetic diseases or conditions that run in your family? No If yes, please identify: N/A Have you or any family members described above had genetic counseling? No If yes, please describe: N/A Are there any members of your family with a history of learning disabilities? Yes If yes, please explain: The donor s half sister was diagnosed with ADHD at the age of 15. She took Concerta for 3 years but she no longer takes it as she seems to have outgrown the ADHD.

8 Medical problems which are present in biological family members: You Mother Father Sibling MGM MGF PGM PGF HEART Stroke Heart attack Heart disease or defect 1. from birth 2. other Hardening of the arteries High blood pressure Hereditary high cholesterol High cholesterol level BLOOD Anemia Sickle-cell anemia Hemophilia/bleeding disorder HIV / AIDS Leukemia Other blood disorder RESPIRATORY Asthma Lung cancer Emphysema Tuberculosis GASTRO-INTESTINAL Ulcer of stomach/duodenum Hepatitis (all types) Cirrhosis Other liver disease Ulcerative colitis Crohn's disease Pyloric stenosis Multiple Polyposis of colon Rectal disorder METABOLIC/ENDOCRINE Diabetes (age of onset) Thyroid disease Goiter Hyperactivity Phenyl Ketonuria (PKU) Cystic fibrosis Dwarfism Lupus/other auto immune diseases URINARY Kidney disease Other disease/defect of urinary tract The donor s mother has Hashimoto s disease. She was diagnosed when she was 39 and it is being controlled with medication (Altroxin).

9 NEUROLOGICAL Migraines Mental retardation Senility before age 50 Multiple Sclerosis Cerebral Palsy Epilepsy/seizure Hydrocephalus Spina bifida neural tube defect Tuberous Sclerosis Parkinsonism Creutzfeldt-Jakob Disease Scoliosis MENTAL HEALTH Depression Schizophrenia Manic depressive/bipolar disorder Alcoholism Drug abuse, misuse or addiction MUSCLE/BONE/JOINTS Muscular dystrophy Loss of muscle coordination Other chronic muscle disease Osteoporosis Marfan Syndrome Arthritis SIGHT/SOUND/SMELL Deafness before age 60 Deformity of the ear Cataracts before age 50 Blindness Colour blindness Severe Myopia Glaucoma Retinoblastoma Retinitis Pigmentosa Other sight/sound/smell disorder SKIN Acne Albinism Eczema Pigmentation disorders Neurofibromatosis Other disorders of the skin CANCER Breast Ovarian Colon Skin Thyroid cervical Uterine Other GENETIC / CHROMOSOME Down Syndrome Turner Syndrome Fragile Syndrome OTHER You Mother Father Sibling MGM MGF PGM PGF