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 - 24oz/wk beer
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:		Eye socket repair - 22, broke my eye socket playing sports
Hospitalization other than surgery:
Age & type of illness:		Pneumonia - 10, pneumonia
Have you ever had any broken bones?
If yes, please give age and description:		Yes - Eye socket, knee to the face playing sports
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:Advil, Vitamin C, Vitamin D - Once or twice a month; 1 or two days ; General pain
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Vitamin C, Vitamin D - 3 times a week ; 1 day; Just to make sure I’m getting it
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - Nearsighted, -2.25/-3
Birth weight lbs8
Birth weight ozs6
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		Yes - Penicillin, swelling of the face
How many sexual partners do you currently have?1
Have you ever had a tattoo?Yes - 2016 Shoulder; 2016 Tricep; 2017 Bicep; 2020 Forearm
Have you ever had your ear(s) or body pierced?No

Family Medical History
See list of questions asked here

Mother's Father Ethnic OriginsSpanish
Mother's Mother Ethnic OriginsItalian
Father's Father Ethnic OriginsGerman
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 61
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 60
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Lyme Disease, age 57, medication when needed
Brothers
Your Brother 1
Question Response
Current age or age at death 30
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 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 85
Living / DeadDead
Cause of death and any treatment prior to deathHeart attack, immediately fatal
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Dementia or degenerative disorders
78
Medication
Your Mother's Mother
Question Response
Current age or age at death 62
Living / DeadDead
Cause of death and any treatment prior to deathKidney failure from diabetes
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes mellitus requiring insulin therapy
15
Insulin
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
Healthy
Your Mother's Sisters 2
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 Mother's Brothers 1
Question Response
Current age or age at death 60
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 82
Living / DeadDead
Cause of death and any treatment prior to deathFell, broke hip, pain meds damaged his body internally
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Alzheimer's
75
Assisted care
Your Father's Mother
Question Response
Current age or age at death 89
Living / DeadDead
Cause of death and any treatment prior to deathComplications of heart attack
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart attack
89
Hospitalization
Leukemia
60
Chemotherapy
Your Father's Sisters 1
Question Response
Current age or age at death 70
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 67
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 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy