Name	Value
NAME	DNRCX
FULL NAME	BLOOD DONOR CONSENT STATMENT
COMMENT	The medical history which I have furnished is true and accurate, to the best of my knowledge. I consent to having the HTLV-III antibody testing performed and understand that I will be informed of the test results, should the test be positive, no sooner than 55 days from today. I hereby grant permission to the Veterans Administration Blood Bank to draw approximately 450 ml. of blood from me, to be used in such a manner as the Blood Bank may deem desirable.

Name

Value

NAME

DNRCX

FULL NAME

BLOOD DONOR CONSENT STATMENT

COMMENT

The medical history which I have furnished is true and accurate, to the best
of my knowledge.  I consent to having the HTLV-III antibody testing
performed and understand that I will be informed of the test results,
should the test be positive, no sooner than 55 days from today.
I hereby grant permission to the Veterans Administration
Blood Bank to draw approximately 450 ml. of blood from me, to be used in
such a manner as the Blood Bank may deem desirable.

DNRCX (51) BLOOD BANK UTILITY (65.4)