| Name | Value |
|---|---|
| NAME | DNRHX |
| FULL NAME | BLOOD DONOR HISTORY QUESTIONS |
| DONOR HISTORY | Are you feeling well today ? Had malaria within the last three years? Had heart disease, chest pain or shortness of breath ? Had convulsions, seizures, or fainting spells ? Had a blood disease or abnormal bleeding ? Been pregnant in past 6 weeks ? Night sweats, Enlarged lymph nodes, Unexplained weight loss ? Unexplained fever, Purple skin lesions, Persistent cough ? White spots or unusual blemishes in mouth ? Consent to having HTLV-III antibody testing done? Had any dental work in past 3 days ? Been hospitalized in past 6 months ? Had blood transfusions, injections, or tattoos in past 6 months ? Had any vaccinations/immunizations in past year ? Traveled outside US in past 3 years ? Ever had jaundice, liver disease, or hepatitis ? Been deferred as a blood donor or had problems donating ? |