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”.
- SUBSCRIBER FIRST NAME :
- SUBSCRIBER LAST NAME :
- CITY :
- STATE / PROVINCE :
- COUNTRY :
- E-MAIL ADDRESS :
- SEX (M/F) :
- DATE OF BIRTH (MM/DD/YY) :
- OCCUPATION :
- RELATION TO PWCF :
- MARITAL STATUS (M/S/D/W) :
- SPOUSE’S NAME :
- CHILDREN / SIBLINGS : NAME RELATIONSHIP SEX(M/F) DOB(M/D/Y) CF(Y/N) a. b. c.
- CF CENTER NAME / CITY :
- TRANSPLANTED (T) OR WAITING FOR TRANSPLANT (W) :
- TRANSPLANT DATE OR WAITING SINCE DATE (MM/YY) :
- TRANSPLANT CENTER HOSPITAL :
- OTHER HEALTH IMPAIRMENTS :
- INTERESTS/HOBBIES :
- BRIEF HISTORY (AGE AT DIAGNOSIS, O2 REQUIREMENTS, ETC.)
