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 - 12oz. of beer or 5oz. of wine
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:		Wisdom teeth removed - Age 18
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 - Age 10, left arm, fell off a bike
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:Omeprazole - As needed; 3 months; Indigestion
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Magnesium glycinate - Daily; Ongoing; Aid in digestion and sleep
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - Near-sighted, -10.00 both eyes
Birth weight lbs8
Birth weight ozsN/A
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?No
Have you ever had your ear(s) or body pierced?No

Family Medical History
Ver lista de perguntas. here

Mother's Father Ethnic OriginsPolish
Mother's Mother Ethnic OriginsPolish
Father's Father Ethnic OriginsRussian
Father's Mother Ethnic OriginWestern European
Is anyone in your family of Ashkenazai Jewish Heritage?Yes
If yes, who?Mother
Your Mother
Question Response
Current age or age at death 73
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Glaucoma
70
Surgery
Your Father
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
Brothers
Your Brother 1
Question Response
Current age or age at death 45
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Sisters
Your Sister 1
Question Response
Current age or age at death 43
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 85
Living / DeadDead
Cause of death and any treatment prior to deathHeart Failure
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
Received a heart transplant at age 70
Other heart disease
65
Heart failure initially diagnosed and treated with medication
High blood pressure
60
Medication
Your Mother's Mother
Question Response
Current age or age at death 83
Living / DeadDead
Cause of death and any treatment prior to deathFainted and never regained consciousness (specific cause unknown)
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems at time of death
Your Mother's Sisters 1
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 Mother's Brothers 1
Question Response
Current age or age at death 76
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Your Mother's Brothers 2
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 Father's Father
Question Response
Current age or age at death 85
Living / DeadDead
Cause of death and any treatment prior to deathLung Cancer (smoker)
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
No other diagnosed health problems at time of death
Your Father's Mother
Question Response
Current age or age at death 70
Living / DeadDead
Cause of death and any treatment prior to deathLymphoma
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
No other diagnosed health problems at time of death
Your Father's Brothers 1
Question Response
Current age or age at death 84
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Stroke
70
Stroke remediation
Your Father's Brothers 2
Question Response
Current age or age at death 25
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)
25
Car accident, no diagnosed health problems at time of death