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 - 24-36 oz. beer/month or 12-18 oz. wine/month
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:		Tonsillectomy at age 6 due to allergies; Wisdom teeth extraction (4 teeth) at age 16
Hospitalization other than surgery:
Age & type of illness:		None
Have you ever had any broken bones?
If yes, please give age and description:		Yes - Broken right thumb at age 9, dropped a bowling ball on it
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:Multivitamin - Once daily; 6 months; General health
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - 20/40
Birth weight lbs9
Birth weight ozs4
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?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 OriginsGerman-Irish
Mother's Mother Ethnic OriginsIrish
Father's Father Ethnic OriginsGerman-Polish
Father's Mother Ethnic OriginPolish
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
Hay fever/Seasonal Allergies/Allergic Rhinitis
30
No treatment
Your Father
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
Depression
25
Situational, cognitive behavioral therapy previously, no longer needs treatment
Brothers
Your Brother 1
Question Response
Current age or age at death 30
Living / DeadDead
Cause of death and any treatment prior to deathDrowned
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems prior to death
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
Healthy
Your Mother's Father
Question Response
Current age or age at death 85
Living / DeadDead
Cause of death and any treatment prior to deathProstate cancer
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Prostate cancer
85
Fatal, diagnosed late stage
Your Mother's Mother
Question Response
Current age or age at death 76
Living / DeadDead
Cause of death and any treatment prior to deathCirrhosis of the liver
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other liver disease
76
Diagnosed at death, Cirrhosis of liver cause by regular drinking, confirmed no alcohol addiction
Your Mother's Sisters 1
Question Response
Current age or age at death 81
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 75
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 71
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
50
Diet changes, Stopped smoking
Your Mother's Brothers 1
Question Response
Current age or age at death 78
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
40
Alcoholics Anonymous (recovering alcoholic); does not drink anymore
Your Father's Father
Question Response
Current age or age at death 50
Living / DeadDead
Cause of death and any treatment prior to deathHeart attack
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart attack
50
Fatal, no treatment
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 65
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 58
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy