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Donor Health History Form

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The document is a Living Donor Transplant Program Health History Form designed for potential organ and tissue donors. It collects comprehensive personal, medical, and lifestyle information to assess the donor's suitability for donation. The form includes sections for demographics, intended recipient details, medical history, and various health-related questions. It emphasizes confidentiality and requires the submission of blood type documentation.

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See more Donor Health History Form versions

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Versions	Form popularity	Fillable & printable
2023	4.7 Satisfied (56 Votes)
2018	4.7 Satisfied (44 Votes)
2014	4.5 Satisfied (48 Votes)

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What is a donor history questionnaire?

The Full-Length PPTA Donor History Questionnaire (DHQ) and Abbreviated Questionnaire are designed to aid plasma sourcing organizations in evaluating a prospective donors history relative to current known safety risks, FDA regulations and recommendations, PPTA voluntary standards, and optionally, European requirements.

What questions do they ask you before you donate blood?

Outline HIV-1 and HIV-2. HTLV-I and HTLV-II. Hepatitis C virus. Hepatitis B virus. West Nile virus. Minipool NAT. Targeted individual donation testing. Identification of viremic donors. Cytomegalovirus. Zika virus.

What is donor requirements?

Donor requirements in a grant proposal refer to the specific guidelines and criteria set by the funding organization that must be followed when applying for a grant. These requirements may include eligibility criteria, application format, budget limitations, reporting guidelines, and other specific instructions.

What would disqualify me from donating blood?

Health History Questionnaire (HHQ) The Health History Questionnaire is the main tool for cancer risk assessment. The HHQ collects your family history and medical information. This is an online form.

What is the health history form?

A health history is part of the Assessment phase of the nursing process. It consists of using directed, focused interview questions and open-ended questions to obtain symptoms and perceptions from the patient about their illnesses, functioning, and life processes.

Is there a blood donation database?

The registry contains more than 9.4 million potential donors in the U.S. The U.S. registry contains more than 246,500 available cord blood units. This total includes more than 122,500 units from the National Cord Blood Inventory (NCBI), with 3,700 NCBI units added in 2024.

What is a health history questionnaire?

During a private and confidential interview, youll answer questions about your health history, places youve traveled, medications that may be in your system and questions to assess infectious disease risk.

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