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:		Never
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:		Dehydration - Age 17, dehydration from influenza
Have you ever had any broken bones?
If yes, please give age and description:		No
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:None - N/A; N/A; N/A
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Multivitamin, fish oil, glucosamine - Daily; 4 years; Multivitamin for overall health, fish oil for eye health, glucosamine for joint health
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - Near-sighted, 20/40
Birth weight lbs8
Birth weight ozs1
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		Yes - Seasonal allergies to pollen, reaction: itching
How many sexual partners do you currently have?1
Have you ever had a tattoo?No
Have you ever had your ear(s) or body pierced?No

Family Medical History
Ver lista de perguntas. here

Mother's Father Ethnic OriginsDutch
Mother's Mother Ethnic OriginsDutch
Father's Father Ethnic OriginsGerman
Father's Mother Ethnic OriginGerman
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 63
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Father
Question Response
Current age or age at death 60
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Brothers
Your Brother 1
Question Response
Current age or age at death 38
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
32
Medication
Sisters
Your Sister 1
Question Response
Current age or age at death 35
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Sons
Your Son 1
Question Response
Current age or age at death 1
Living / DeadLiving
Problemas de Saúde
Saudável
Daughters
Your Daughter 1
Question Response
Current age or age at death 3
Living / DeadLiving
Problemas de Saúde
Saudável
Your Mother's Father
Question Response
Current age or age at death 72
Living / DeadDead
Cause of death and any treatment prior to deathLiver failure, no treatment
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
No other diagnosed health problems at time of death
Your Mother's Mother
Question Response
Current age or age at death 81
Living / DeadDead
Cause of death and any treatment prior to deathHeart attack, no treatment
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
Had a pacemaker and maintained an active lifestyle
Your Mother's Sisters 1
Question Response
Current age or age at death 66
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Mother's Sisters 2
Question Response
Current age or age at death 61
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Mother's Brothers 1
Question Response
Current age or age at death 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Father's Father
Question Response
Current age or age at death 83
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Heart attack
75
Valve stent
Inflammatory bowel disease
76
Chemotherapy
Your Father's Mother
Question Response
Current age or age at death 80
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Father's Sisters 1
Question Response
Current age or age at death 56
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Father's Sisters 2
Question Response
Current age or age at death 18
Living / DeadDead
Cause of death and any treatment prior to deathCar Accident
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Early death (less than age 50)
18
Car Accident, no health problems at time of death
Your Father's Brothers 1
Question Response
Current age or age at death 54
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável