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 - 2 oz; various liquor (whiskey, gin, tequila, vodka)
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?Yes
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:		Tympanostomy tubes; Tonsillectomy; Wisdom teeth removed - Age 3, for ear infections; Age 5; Age 21
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 - 9, small bone in midfoot; fell off a jungle gym
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:Daily Vegan Supplement (Complement brand) - Daily; 1 years; Plant Based / Vegan diet lacks sufficient B12, D3, Omegas, etc..
Do you wear glasses or contact lenses?
Are you near or far-sighted?		No
Birth weight lbs7
Birth weight ozs9
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?0
Have you ever had a tattoo?Yes - 2017 Shoulder/upper back/upper chest
Have you ever had your ear(s) or body pierced?No

Family Medical History
See list of questions asked here

Mother's Father Ethnic OriginsPolish
Mother's Mother Ethnic OriginsLuxembourgian
Father's Father Ethnic OriginsMexican
Father's Mother Ethnic OriginFrench-Spanish
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 56
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 56
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
Your Brother 2
Question Response
Current age or age at death 25
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 37
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 42
Living / DeadDead
Cause of death and any treatment prior to deathBleeding ulcer
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Diagnosed with polio at age 12 and received an artificial hip replacement
Your Mother's Mother
Question Response
Current age or age at death 65
Living / DeadDead
Cause of death and any treatment prior to deathHeart Attack
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
55
None
Your Mother's Sisters 1
Question Response
Current age or age at death 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 2
Question Response
Current age or age at death 59
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 3
Question Response
Current age or age at death 52
Living / DeadDead
Cause of death and any treatment prior to deathCar Accident
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems at time of death
Your Father's Father
Question Response
Current age or age at death 56
Living / DeadDead
Cause of death and any treatment prior to deathHeart Attack
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
56
None
Your Father's Mother
Question Response
Current age or age at death 79
Living / DeadDead
Cause of death and any treatment prior to deathCOPD
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Breast cancer
59
Estrogen blockers
Your Father's Sisters 1
Question Response
Current age or age at death 59
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy