CF Bio

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Last Update 5/97

The CF-BIO is a compilation of submitted personal information from members of CYSTIC-L maintained by Mike Laird. Its purpose is to help us have a better idea of whom we are communicating with and to serve as a resource for help on specific issues. The CF-BIO is publicly available and can be viewed or downloaded from Mike’s web page at http://www.bcpl.lib.md.us/~jlaird/jlaird.html. Scroll down to “cf-stuff” and click the “cf-bio” link. Mike can also email you the entire CF-BIO file on request, in case you can’t reach it on the web.

To submit an entry for the CF-BIO, please follow the format shown below (this keeps our processing time to a minimum). Each item is numbered for reference. Simply type the info into the form on Mike’s web page and send it in! Alternatively, you may create an e-mail message containing each number followed by your response. Answer any or all of the items you wish. When you complete your CF-BIO send it to: [email protected] with the subject line of

“CF-BIO”.

  1. SUBSCRIBER FIRST NAME :
  2. SUBSCRIBER LAST NAME :
  3. CITY :
  4. STATE / PROVINCE :
  5. COUNTRY :
  6. E-MAIL ADDRESS :
  7. SEX (M/F) :
  8. DATE OF BIRTH (MM/DD/YY) :
  9. OCCUPATION :
  10. RELATION TO PWCF :
  11. MARITAL STATUS (M/S/D/W) :
  12. SPOUSE’S NAME :
  13. CHILDREN / SIBLINGS : NAME RELATIONSHIP SEX(M/F) DOB(M/D/Y) CF(Y/N) a. b. c.
  14. CF CENTER NAME / CITY :
  15. TRANSPLANTED (T) OR WAITING FOR TRANSPLANT (W) :
  16. TRANSPLANT DATE OR WAITING SINCE DATE (MM/YY) :
  17. TRANSPLANT CENTER HOSPITAL :
  18. OTHER HEALTH IMPAIRMENTS :
  19. INTERESTS/HOBBIES :
  20. BRIEF HISTORY (AGE AT DIAGNOSIS, O2 REQUIREMENTS, ETC.)

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