PHYSICAL CHARACTERISTICS
| Height: 5' 10" | Weight: 165 | Hair Color: Light Brown |
| Eye Color: Blue | Hair Type: Straight | Complexion: Fair |
| Race: Caucasian | Mother's Ethnic Background: Basque,
Danish
Father's Ethnic Background: German, English |
|
| Blood Type: A + | ||
FAMILY AND MEDICAL HISTORY
For each item below, if there is a history of the condition,
the condition poses a risk of one percent or less to offspring.
The family relationship is indicated.
| Alcoholism: | Edema: | Mental disorders: |
| Allergy: | Emphysema: | Mental retardation: |
| Anemia: | Epilepsy: | Miscarriages: |
| Asthma: | Glaucoma: | Stillbirths: |
| Blindness: | Goiter: | Migraine: |
| Cancer: | Gout: | Muscular dystrophy: |
| Cataracts: | Heart attack: | Myasthenia gravis: |
| Cirrhosis: | Heart disease: | Paraplegia: |
| Cleft palate or lip: | Hemophilia: | Parkinson's: |
| Club foot: | Hermaphroditism: | Psoriasis: |
| Color blindness: | Hernia, inguinal: | Sickle cell anemia: |
| Cystic fibrosis: | Huntington's chorea: | Tay Sachs disease: |
| Deafness: | Hypertension: | Thalassemia: |
| Diabetes: | Jaundice: | Undescended testicles: |
| Dislocated hip: | Juvenile arthritis: | |
| Eczema: | Lymphedema: |
ABBREVIATIONS: M=Mother, or Maternal S=Sibling
F,P=Father, or Paternal
N=Nephew or Niece GF, GM=Grandfather, Grandmother
A=Aunt U=Uncle C=Cousin
MEDICAL HISTORY COMMENTS: The donor's father (age 44), mother
(42), PGF (72), PGM (77), MGF (75), MGM (73), one brother (21), and one
sister (18) are living and in good health. The donor's parents are both
only children so there are no aunts, uncles or cousins.
| EDUCATION: | Subject of study | Location of University | Type of University |
| > 1 year college | |||
| Baccalaureate Degree | (Pre-Med) | Boise, ID | large state university |
| Master's Degree | |||
| Professional Degree | D.C. | Oregon | private chiropractic college |
OCCUPATION: Chiropractor
STATE OF BIRTH: Idaho YEAR OF BIRTH: 1971 RELIGION: Mormon
Social History:
1. Do you have any special talents?
I can play the saxophone.
I enjoy and find pleasure helping people in dealing with problems.
2. Are there any special talents that seem to run in your family? (athletics, music, artistic, etc.)
In my family we are all very athletic and enjoy sports.
My younger brother and sister both play the piano.
My mom sings.
3. What are your interests and hobbies?
I enjoy all sports, especially water skiing which I've competed and placed in amateur level competitions. Nearly all sports I have participated in and enjoy.
I like to read self-improvement books as well as others.
I enjoy theater, opera, ballet, etc.
And I love children.
4. What did you enjoy studying in high school and college?
Science, English, psychology, all classes dealing with human anatomy
and physiology, physics.
5. High School GPA 3.65 College GPA 3.45 I.Q.
6. How would you describe your personality characteristics?
I think I'm the type of person able to persuade a group of people into
my way of thinking and leading that group in carrying out that thinking.
I can also be the guy that supports whoever is in charge and help that
person be the best leader they can be. I love people, and that 's why I
picked the health care profession. I have a great sense of humor and feel
comfortable in most any setting I've ever found myself in. I'm easy-going,
and I feel like I'm always looking out for everyone's best interest.
7. Undergraduate major: Pre-Med
Graduate major: Chiropractic Medicine
Additional Descriptive Characteristics:
Handedness: Foot/Shoe Size:
Hairy Chest: Hairy: Beard Color:
Any Distinguishing Features (Dimples, Cleft Chin, Roman Nose, Freckles,
etc.):
Acne problems: None, skin is clear.
Reactivity/Sensitivity to sun exposure:
Do you smoke?
No
Family Social History:
| Education | Occupation | Interests | |
| PGF | high school (12 years) | farmer | fishing, old people stuff |
| PGM | college (4 years) | Registered Nurse | sewing, cooking, baking |
| MGF | high school (12 years) | mechanic | fishing, old people stuff |
| MGM | high school (12 years) | homemaker | sewing, cooking, baking |
| Father | college (2 years) | armed services | sports |
| Mother | high school (12 years) | daycare | family, children |
| Brother | college (3 years) | pre-med | sports, outdoor activities, snow boarding, hiking, travel |
| Sister | college (1 year) | bilingual teacher | arts, children, reading, theater |