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:		Rarely - 2 oz/wk, wine
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 removed - 18, 20, 24
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:Multivitamin - Daily; 1 year; General health
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Multivitamin - Daily; 1 year; General health
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - 0.2/0.2
Birth weight lbs6
Birth weight ozs1
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		Yes - cumin, cinnamon; hives
How many sexual partners do you currently have?0
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 OriginsChinese
Mother's Mother Ethnic OriginsChinese
Father's Father Ethnic OriginsChinese
Father's Mother Ethnic OriginChinese
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 blood pressure
58
Medications
Your Father
Question Response
Current age or age at death 69
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 47
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 92
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
65
Medications
Diabetes mellitus not requiring insulin therapy
65
Diet
Your Mother's Mother
Question Response
Current age or age at death 87
Living / DeadDead
Cause of death and any treatment prior to deathChronic Heart Failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other heart disease
75
Stent for Angina
High blood pressure
65
Medications
Your Mother's Sisters 1
Question Response
Current age or age at death 64
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 58
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Gallstones
50
Surgery
Kidney Stones
20
Ultrasound
Your Father's Father
Question Response
Current age or age at death 40
Living / DeadDead
Cause of death and any treatment prior to deathAppendicitis, no treatment
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Early death (less than age 50)
40
Appendicitis, no treatment
Your Father's Mother
Question Response
Current age or age at death 100
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No known health problems prior to death.
Your Father's Sisters 1
Question Response
Current age or age at death 72
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 74
Living / DeadDead
Cause of death and any treatment prior to deathLung Cancer, Chemotherapy
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
70
Chemotherapy
Your Father'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
Diabetes mellitus requiring insulin therapy
45
Diet, Insulin
Brain tumor
54
Surgery
Other diseases of the nervous system
54
Meningitis due to tooth infection, hospitalization