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 - 4oz. wine or 12oz. 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:		Wisdom teeth extraction - Age 18
Hospitalization other than surgery:
Age & type of illness:		No
Have you ever had any broken bones?
If yes, please give age and description:		Yes - Tibia at age 2, child at daycare jumped on my leg
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:N/A - 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:Vitamin D - Daily; Indefinitely ; Immune health, restful sleep
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - 20/50
Birth weight lbs8
Birth weight ozs15
Recent weight loss or gain?
# of lbs and reason:		Yes - 10lbs, staying indoors due to pandemic
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		Yes - Bactrim/sulfa drugs causes hives, Seasonal pollen causes stuffy nose
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 OriginsColombian
Mother's Mother Ethnic OriginsColombian
Father's Father Ethnic OriginsEnglish, Welsh, Norwegian, Irish
Father's Mother Ethnic OriginEnglish
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 62
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High cholesterol
55
Medication
Asthma
50
Seasonal asthma, uses an inhaler as needed
Other
 
Impacted parathyroid removed at age 62 (surgery)
Your Father
Question Response
Current age or age at death 65
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 27
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Anxiety
20
Medication
Eczema
27
Medication
Your Brother 2
Question Response
Current age or age at death 26
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Asthma
13
Exercise induced asthma, inhaler as needed
Your Mother's Father
Question Response
Current age or age at death 75
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other heart disease
75
None
Your Mother's Mother
Question Response
Current age or age at death 68
Living / DeadDead
Cause of death and any treatment prior to deathLiver Cancer, no treatment
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Liver Cancer
67
Cancer spread before she could receive a transplant.
Your Mother's Sisters 1
Question Response
Current age or age at death 58
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Cancer of cervix, ovaries, or uterus
57
Chemotherapy
Your Mother's Brothers 1
Question Response
Current age or age at death 63
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 60
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Mental retardation
11
Caused by meningitis
Any other sight/sound/smell disorder
11
Vision loss due to meningitis
Your Father's Father
Question Response
Current age or age at death 55
Living / DeadDead
Cause of death and any treatment prior to deathLung cancer
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
54
Chemotherapy and radiation
Multiple sclerosis
35
Medication controlled
Your Father's Mother
Question Response
Current age or age at death 83
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other heart disease
83
None
Dementia or degenerative disorders
80
Medication controlled
Suicide or suicide attempts
30
Medication and therapy
Your Father's Brothers 1
Question Response
Current age or age at death 63
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
30
Alcoholism, therapy