This donor is a healthy carrier for a genetic disease.
Please see his Genetic Testing Summary and Acknowledgment of Genetic Risk for details
Updated medical information on the donor and his family (if applicable) will be included at the bottom of the Summary Profile

Personal Behavior History

Question Response
Current alcohol use:
If yes, oz./week and type of alcohol:		Rarely - On average less than 1 oz a week, and 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?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:		Palate expansion, Wisdom teeth removal, Right hand amputation, Jaw Surgery - Age 18, cosmetic; Age 16, the wisdom teeth were causing crowding; Age 19, fireworks accident; Age 20, to fix slight underbite
Hospitalization other than surgery:
Age & type of illness:		Hand amputation, burn injuries - Age 19, firework accident
Have you ever had any broken bones?
If yes, please give age and description:		Yes - Age 4, broke my arm around when my brother ran over it with 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:IV pain meds and antibiotics for surgery, NSAID, acetaminophen, dextromethorphan, doxylamine, zinc, magnesium, calcium, ashwagandha - Vitamins and herbs taken 4 times weekly. Everything else taken when needed usually weekly or monthly.; As needed; NSAID and acetaminophen used for pain, dextromethorphan and doxylamine used for colds, zinc, magnesium, calcium, ashwagandha used as wee
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Zinc, Magnesium, Calcium, Ashwagandha - 4 times weekly ; Have been taking for 2 months.; All used as weekly supplements
Do you wear glasses or contact lenses?
Are you near or far-sighted?		No
Birth weight lbs8
Birth weight ozs2
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		Yes - Lactose intolerance: slight stomach discomfort.
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 OriginsNorwegian
Mother's Mother Ethnic OriginsRussian
Father's Father Ethnic OriginsEnglish
Father's Mother Ethnic OriginSwedish
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 59
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 58
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 21
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 28
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 64
Living / DeadDead
Cause of death and any treatment prior to deathProstate Cancer, chemotherapy and radiation
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Prostate cancer
61
Chemotherapy and radiation
Heart attack
56
Medication
Ulcer of stomach/duodenum
58
Medication
Your Mother's Mother
Question Response
Current age or age at death 71
Living / DeadDead
Cause of death and any treatment prior to deathKidney disease caused by high blood pressure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
64
Medication
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 57
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Drug abuse, misuse, or addiction
43
None
Your Father's Father
Question Response
Current age or age at death 88
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Mother
Question Response
Current age or age at death 86
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Sisters 1
Question Response
Current age or age at death 57
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Sisters 2
Question Response
Current age or age at death 54
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Sisters 3
Question Response
Current age or age at death 52
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy