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:		Frequently - 12-24 oz. beer/ week
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:		None - N/A
Hospitalization other than surgery:
Age & type of illness:		None - N/A
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:Multivitamins and fish oil - Daily; N/A; General health
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - 18/20
Birth weight lbs9
Birth weight ozs10
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
See list of questions asked here

Mother's Father Ethnic OriginsGerman
Mother's Mother Ethnic OriginsGerman
Father's Father Ethnic OriginsPolish
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 69
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father
Question Response
Current age or age at death 74
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Brothers
Your Brother 1
Question Response
Current age or age at death 32
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Sisters
Your Sister 1
Question Response
Current age or age at death 44
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Sister 2
Question Response
Current age or age at death 41
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Daughters
Your Daughter 1
Question Response
Current age or age at death 5
Living / DeadLiving
Health Problems
Healthy
Your Mother's Father
Question Response
Current age or age at death 89
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure due to aging
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
89
Fatal
Your Mother's Mother
Question Response
Current age or age at death 92
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure due to aging
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
92
Fatal
Your Mother's Sisters 1
Question Response
Current age or age at death 85
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Brothers 1
Question Response
Current age or age at death 89
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure due to aging
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
85
Fatal, general decline with aging
Your Father's Father
Question Response
Current age or age at death 78
Living / DeadDead
Cause of death and any treatment prior to deathHeart disease due to smoking throughout lifetime
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart disease (smoker)
78
Fatal
Your Father's Mother
Question Response
Current age or age at death 85
Living / DeadDead
Cause of death and any treatment prior to deathGeneral health decline following death of husband
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems prior to death.
Your Father's Brothers 1
Question Response
Current age or age at death 78
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Brothers 2
Question Response
Current age or age at death 70
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy