This donor is a healthy carrier for a genetic disease.
Please see his Genetic Testing Summary and Acknowledgment of Genetic Risk for details

Personal Behavior History

Question Response
Current alcohol use:
If yes, oz./week and type of alcohol:		Occasionally - Beer, 16 oz
Tobacco use: Do you smoke?
If yes, #/day and for how long:		No
If you did smoke but quit, when did you last smoke?N/A
For how many years?N/A
Do you sleep well?Yes
Do you exercise on regular basis?Yes
Is your diet well balanced?
If no, explain:		Yes
Are you a vegetarian?No
Any dietary restrictions?
If yes, explain:		No

Sexual History

Have you ever had sex with:
Question Response
A partner whose sexual background you are unsure of in the past 12 months?No

Donor Genetic History

Question Response
Do you have a history of a speech disorder; such as a speech impediment, stuttering, delayed speech development, etc.?
If yes, explain:		No
Do you have learning differences, such as dyslexia?
If yes, explain:		No
Were you or any family members born with any birth defects?
If yes, explain:		No

Donor Medical History

Question Response
List any operations:
Age & reason:		N/A - N/A
Hospitalization other than surgery:
Age & type of illness:		N/A - N/A
Have you ever had any broken bones?
If yes, please give age and description:		Yes - 23, slipped on some ice, broke my ankle
Have you ever had any serious illnesses?
If yes, please give age and description:		No
Are you presently under a physician's care for any reason?
If yes, please describe:		No
List all drugs you have taken in past 12 months (prescription, nonprescription, herbal, and sports supplements, and recreational). Include drug, frequency and duration taken, and reason:Marijuana, Ashwagandha, B12 - 1 time a week, daily, daily, ; 3 years, 6 months, 4 years, ; Recreation, Stress management, energy and metabolism
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:B12, Ashwagandha - Daily, daily; 4 years, 6 months; Energy/metabolism, Stress management
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - Near sighted, -7.25/-7.50
Birth weight lbs8
Birth weight ozs2
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		No
How many sexual partners do you currently have?1
Have you ever had a tattoo?Yes - 2019 Upper right tricep
Have you ever had your ear(s) or body pierced?No

Family Medical History
Ver lista de perguntas. here

Mother's Father Ethnic OriginsGerman
Mother's Mother Ethnic OriginsGerman
Father's Father Ethnic OriginsEnglish-Danish
Father's Mother Ethnic OriginEnglish-German
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Your Mother
Question Response
Current age or age at death 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Obesity
50
Reduced weight through diet and exercise
Your Father
Question Response
Current age or age at death 59
Living / DeadDead
Cause of death and any treatment prior to deathCancer - smoker
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
58
Chemotherapy
Any cancer not mentioned above
58
Chemotherapy
Brothers
Your Brother 1
Question Response
Current age or age at death 36
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Asthma
1
Inhaler
Sisters
Your Sister 1
Question Response
Current age or age at death 31
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Mother's Father
Question Response
Current age or age at death 21
Living / DeadDead
Cause of death and any treatment prior to deathKilled in WW 2
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Early death (less than age 50)
21
Casualty of war
Your Mother's Mother
Question Response
Current age or age at death 89
Living / DeadDead
Cause of death and any treatment prior to deathKidney failure
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Glaucoma
85
Eye drops
Your Mother's Brothers 1
Question Response
Current age or age at death 68
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Stomach Cancer
55
Chemotherapy
Your Mother's Brothers 2
Question Response
Current age or age at death 67
Living / DeadDead
Cause of death and any treatment prior to deathAspiration/pneumonia
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Pneumonia
67
Antibiotics, hospitalization
Other diseases of the nervous system
30
Suffered a traumatic brain injury that led to a neurodegenerative disorder. Treated with surgery, physical therapy, nursing home care.
Your Father's Father
Question Response
Current age or age at death 92
Living / DeadDead
Cause of death and any treatment prior to deathHeart disease
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
50
Medications
Your Father's Mother
Question Response
Current age or age at death 102
Living / DeadDead
Cause of death and any treatment prior to deathSpecific cause unknown, possibly alcohol related
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Diabetes mellitus requiring insulin therapy
50
Insulin
Thyroid disease
69
Medications
Your Father's Brothers 1
Question Response
Current age or age at death 72
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Pancreatic Cancer
70
Chemotherapy