Medical History & Eligibility Information
Prior to completing the medical history questionnaire, donors MUST FIRST READ general blood donation material and a medication deferral list. The questions below will be answered YES or NO. If you are trying to determine your eligibility to donate and answer "yes" to one of the questions (excluding #1 and #5) please call 650-723-7831 to clarify.
A "yes" response does not necessarily make you ineligible to donate.
The following questions are included in the medical history:
| Are you | |
| 1. | Feeling healthy and well today? |
| 2. | Currently taking an antibiotic? |
| 3. | Currently taking any other medication for an infection? |
| Please read the Medication Deferral List. | |
| 4. | Are you now taking or have you ever taken any medications on the Medication Deferral List? |
| 5. | Have you read the educational materials in the past 48 hours? |
| 6. | Have you taken aspirin or anything that has aspirin in it? |
| In the past 6 weeks | |
| 7. | Female donors: Have you been pregnant or are you pregnant now? |
| In the past 8 weeks have you | |
| 8. | Donated blood, platelets or plasma? |
| 9. | Had any vaccinations or other shots? |
| 10. | Had contact with someone who had a smallpox vaccination? |
| In the past 16 weeks | |
| 11. | Have you donated a double unit of red cells using an apheresis machine? |
| In the past 12 months have you | |
| 12. | Had a blood transfusion? |
| 13. | Had a transplant such as organ, tissue, or bone marrow? |
| 14. | Had a graft such as bone or skin? |
| 15. | Come into contact with someone else’s blood? |
| 16. | Had an accidental needle-stick? |
| 17. | Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus? |
| 18. | Had sexual contact with a prostitute or anyone else who takes money or drugs or other payment for sex? |
| 19. | Had sexual contact with anyone who has ever used needles to take drugs or steroids, or anything not prescribed by their doctor? |
| 20. | Had sexual contact with anyone who has hemophilia or has used clotting factor concentrates? |
| 21. | Female donors: Had sexual contact with a male who has ever had sexual contact with another male? |
| 22. | Had sexual contact with a person who has hepatitis? |
| 23. | Lived with a person who has hepatitis? |
| 24. | Had a tattoo? |
| 25. | Had ear or body piercing? |
| 26. | Had or been treated for syphilis or gonorrhea? |
| 27. | Been in juvenile detention, lockup, jail, or prison for more than 72 hours? |
| In the past three years have you | |
| 28. | Been outside the United States or Canada? |
| From 1980 through 1996 | |
| 29. | Did you spend time that adds up to three (3) months or more in the United Kingdom? (Review list of countries in the UK) |
| 30. | Were you a member of the U.S. military, a civilian military employee, or a dependent of a member of the U.S. military? |
| From 1980 to the present, did you | |
| 31. | Spend time that adds up to five (5) years or more in Europe? (Review list of countries in Europe.) |
| 32. | Receive a blood transfusion in the United Kingdom or France? (Review list of countries in the UK.) |
| From 1977 to the present, have you | |
| 33. | Received money, drugs, or other payment for sex? |
| 34. | Male donors: had sexual contact with another male, even once? |
| Have you EVER | |
| 35. | Had a positive test for the HIV/AIDS virus? |
| 36. | Used needles to take drugs, steroids, or anything not prescribed by your doctor? |
| 37. | Used clotting factor concentrates? |
| 38. | Had hepatitis? |
| 39. | Had malaria? |
| 40. | Had Chagas’ disease? |
| 41. | Had babesiosis? |
| 42. | Received a dura mater (or brain covering) graft? |
| 43. | Had any type of cancer, including leukemia? |
| 44. | Had any problems with your heart or lungs? |
| 45. | Had a bleeding condition or a blood disease? |
| 48. | Have any of your relatives had Creutzfeldt-Jakob disease? |
| 49. | Been pregnant, had an abortion or a miscarriage? |
| 49a. | Since your last donation, have you been pregnant, had an abortion or a miscarriage? |
Additional restrictions may apply. Please call 1-888-723-7831 to make an appointment, and to inquire about your eligibility.
| England | Wales | Gibraltar |
| Northern Ireland | Isle of Man | Channel Islands |
| Scotland | Falkland Islands |
| Albania Austria Belgium Bosnia-Herzegovina Bulgaria Croatia Czech Republic Denmark |
Finland France Germany Greece Hungary Republic of Ireland Italy Liechtenstein |
Luxembourg Macedonia Netherlands Norway Poland Portugal Romania Slovak Republic |
Slovenia Spain (including: The Canary Islands Penon de Velez de La Gomera, Penon De Ahucemas, Islas Chafarinas, Centa and Melilla) Sweden Switzerland United Kingdom Federal Republic of Yugoslavia(Kosovo, Montenegro Serbia, Yugoslavia) |