Beginning at 12:01 a.m. on the day of your donation appointment, check the “me” tab on this app and click the button under your upcoming appointments that says fill out SBC preCheck™. If you have notifications turned on, you should get a reminder to complete your SBC preCheck™ on the day of your appointment as well.
No appointment? No problem! Just visit our website link instead at stanfordbloodcenter.org/precheck on the day you will be walking in to donate, fill out SBC preCheck™, and bring your QR code with you for check-in.
The following questions are included in the medical history questionnaire:
ARE YOU
| 1 | Feeling healthy and well today? | Y | N |
| 2 | Currently taking an antibiotic? | Y | N |
| 3 | Currently taking any other medication for an infection? | Y | N |
| 4 | Pregnant now? | Y | N |
| 5 | Have you taken any medications on the Medication Deferral List in the time frames indicated? (Review the Medication Deferral List.) | Y | N |
| 6 | Have you read the blood donor educational materials today? | Y | N |
IN THE PAST 48 HOURS
| 7 | Have you taken aspirin or anything that has aspirin in it? | Y | N |
IN THE PAST 8 WEEKS, HAVE YOU
| 8 | Donated blood, platelets or plasma? | Y | N |
| 9 | Had any vaccinations or other shots? | Y | N |
| 10 | Had contact with someone who was vaccinated for smallpox in the past 8 weeks? | Y | N |
IN THE PAST 3 MONTHS, HAVE YOU
| 11 | Taken any medication by mouth (oral) to prevent an HIV infection? (i.e., PrEP or PEP) | Y | N |
| 12 | Had sexual contact with a new partner? (refer to the examples of “new partner” in the Blood Donor Educational Material)? | Y | N |
| 13 | Had sexual contact with more than one partner? | Y | N |
| 14 | Had sexual contact with anyone who has ever had a positive test for HIV infection? | Y | N |
| 15 | Received money, drugs, or other payment for sex? | Y | N |
| 16 | Had sexual contact with anyone who has, in the past 3 months, received money, drugs or other payment for sex? | Y | N |
| 17 | Used needles to inject drugs, steroids, or anything not prescribed by your doctor? | Y | N |
| 18 | Had sexual contact with anyone who has used needles in the past 3 months to inject drugs, steroids, or anything not prescribed by their doctor? | Y | N |
| 19 | Had syphilis or gonorrhea or been treated for syphilis or gonorrhea? | Y | N |
| 20 | Had sexual contact with a person who has hepatitis? | Y | N |
| 21 | Lived with a person who has hepatitis? | Y | N |
| 22 | Had an accidental needle-stick? | Y | N |
| 23 | Come into contact with someone else’s blood? | Y | N |
| 24 | Had a tattoo? | Y | N |
| 25 | Had ear or body piercing? | Y | N |
| 26 | Had a blood transfusion? | Y | N |
| 27 | Had a transplant such as organ, tissue, or bone marrow? | Y | N |
| 28 | Had a graft such as bone or skin? | Y | N |
IN THE PAST 16 WEEKS, HAVE YOU
| 29 | Donated a double unit of red blood cells using an apheresis machine? | Y | N |
IN THE PAST 12 MONTHS, HAVE YOU
| 30 | Been in juvenile detention, lockup, jail, or prison for 72 hours or more consecutively? | Y | N |
IN THE PAST TWO YEARS, HAVE YOU
| 31 | Received any medication by injection to prevent HIV infection? (i.e., long-acting antiviral PrEP or PEP) | Y | N |
IN THE PAST THREE YEARS, HAVE YOU
| 32 | Been outside the United States or Canada? | Y | N |
HAVE YOU EVER
| 33 | Had a positive test for the HIV infection? | Y | N |
| 34 | Taken any medication to treat HIV infection? | Y | N |
| 35 | Been pregnant? | Y | N |
| 36 | Had malaria? | Y | N |
| 37 | Received a dura mater (or brain covering) graft or xenotransplantation product? | Y | N |
| 38 | Had any type of cancer, including leukemia? | Y | N |
| 39 | Had any problems with your heart or lungs? | Y | N |
| 40 | Had a bleeding condition or a blood disease? | Y | N |
| 41 | Had a positive test result for Babesia? | Y | N |
ADDITIONAL QUESTIONS
| 42 | In the past 28 days, have you traveled outside the United States? | Y | N |
| 43 | In the past 14 days, have you had symptoms of a confirmed or suspected COVID-19 infection or have you had a positive COVID-19 test? | Y | N |
Additional restrictions may apply.