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 - 36 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:		Yes - Fractured arm when I fell during a basketball game at 11-12. Broken foot bone on exterior of foot after a motorcycle accident at age 20.
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:Acetaminophen, Ibuprofen, Creatine, Benedryl - 2 times a day for pain relievers, once a week for Benadryl when seasonal allergies become an issue; 2-3 weeks; Sprained foot and was in pain
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Creatine - 3 times a week; 6 months; Help with gaining muscle
Do you wear glasses or contact lenses?
Are you near or far-sighted?		No
Birth weight lbs8
Birth weight ozs8
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		Yes - Pollens and cats, watery eyes
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 OriginsItaly
Mother's Mother Ethnic OriginsItaly
Father's Father Ethnic OriginsGermany
Father's Mother Ethnic OriginItaly
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 68
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Osteoarthritis
60
Cortisone shots into joints (hands)
Your Father
Question Response
Current age or age at death 62
Living / DeadDead
Cause of death and any treatment prior to deathLung Cancer, immunotherapy
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
61
Immunotherapy, heavy smoker
Color blindness
10
None, red-green colorblind
Brothers
Your Brother 1
Question Response
Current age or age at death 27
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Father
Question Response
Current age or age at death 91
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Ulcer of stomach/duodenum
91
Medication - ulcers from taking painkillers for leg pain (amputation after an accident)
Your Mother's Mother
Question Response
Current age or age at death 74
Living / DeadDead
Cause of death and any treatment prior to deathParkinson's
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Parkinson's disease
60
Levodopa
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
Health Problems
Healthy
Your Mother's Brothers 1
Question Response
Current age or age at death 61
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Brothers 2
Question Response
Current age or age at death 51
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Father
Question Response
Current age or age at death 68
Living / DeadDead
Cause of death and any treatment prior to deathUnknown (estranged)
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Health problems unknown (estranged)
Your Father's Mother
Question Response
Current age or age at death 34
Living / DeadDead
Cause of death and any treatment prior to deathSmoke Inhalation from a house fire
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems at time of death
Your Father's Sisters 1
Question Response
Current age or age at death 66
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Brothers 1
Question Response
Current age or age at death 67
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 61
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes mellitus requiring insulin therapy
40
Insulin