Family Profile

We build this profile with you gradually — a question here and there in chat, and facts we find in documents you upload (always with your confirmation first). Answer anything below anytime, or let it fill in over time.

Child's name

Family last name

Date of birth

Sex assigned at birth

Gender identity (if different, and age-appropriate)

Country of residence

State / region / province

Community setting

Race

Hispanic or Latino ethnicity

Primary language spoken at home

Number of siblings

Patient's birth order among siblings

Parental consanguinity (blood relation between parents)

Known family history of CCHS or a PHOX2B mutation in a relative

If yes, relationship of affected relative(s)

Household composition

Primary caregiver's employment status

Primary caregiver's highest level of education

Household annual income range

Primary type of health insurance / coverage

Travel time / distance to nearest CCHS specialty center

Travel time / distance to nearest hospital with a pediatric ICU

Medical Information

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Your conversations

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Your data is stored privately and never shared without your explicit consent. It is used solely to personalize your experience within CCHS Compass.