{"id":597,"date":"2022-03-30T09:02:48","date_gmt":"2022-03-30T16:02:48","guid":{"rendered":"https:\/\/api.stanfordbloodcenter.org\/admin\/?page_id=597"},"modified":"2023-10-19T09:20:29","modified_gmt":"2023-10-19T16:20:29","slug":"medical-history-questionnaire","status":"publish","type":"page","link":"https:\/\/api.stanfordbloodcenter.org\/admin\/medical-history-questionnaire\/","title":{"rendered":"Medical History Questionnaire"},"content":{"rendered":"\n

Beginning at 12:01 a.m. on the day of your donation appointment<\/strong>, check the “me” tab on this app and click the button under your upcoming appointments that says fill out SBC pre<\/em>Check\u2122<\/strong>. If you have notifications turned on, you should get a reminder to complete your SBC pre<\/em>Check\u2122 on the day of your appointment as well. <\/p>\n\n\n\n

No appointment? No problem! Just visit our website link instead at stanfordbloodcenter.org\/precheck<\/a> on the day you will be walking in to donate, fill out SBC pre<\/em>Check\u2122, and bring your QR code with you for check-in.<\/p>\n\n\n\n

The following questions are included in the medical history questionnaire:<\/p>\n\n\n\n

ARE YOU<\/strong><\/p>\n\n\n\n

1<\/td>Feeling healthy and well today?<\/td>Y<\/td>N<\/td><\/tr>
2<\/td>Currently taking an antibiotic?<\/td>Y<\/td>N<\/td><\/tr>
3<\/td>Currently taking any other medication for an infection?<\/td>Y<\/td>N<\/td><\/tr>
4<\/td>Pregnant now?<\/td>Y<\/td>N<\/td><\/tr>
5<\/td>Have you taken any medications on the Medication Deferral List in the time frames indicated? (Review the Medication Deferral List<\/a>.)<\/td>Y<\/td>N<\/td><\/tr>
6<\/td>Have you read the blood donor educational materials<\/a> today?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

IN THE PAST 48 HOURS<\/strong><\/p>\n\n\n\n

7<\/td>Have you taken aspirin or anything that has aspirin in it?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

IN THE PAST 8 WEEKS, HAVE YOU<\/strong><\/strong><\/p>\n\n\n\n

8<\/td>Donated blood, platelets or plasma?<\/td>Y<\/td>N<\/td><\/tr>
9<\/td>Had any vaccinations or other shots?<\/td>Y<\/td>N<\/td><\/tr>
10<\/td>Had contact with someone who was vaccinated for smallpox in the past 8 weeks?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

IN THE PAST 3 MONTHS, HAVE YOU<\/strong><\/p>\n\n\n\n

11<\/td>Taken any medication by mouth (oral) to prevent an HIV infection? (i.e., PrEP or PEP)<\/td>Y<\/td>N<\/td><\/tr>
12<\/td>Had sexual contact with a new partner? (refer to the examples of \u201cnew partner\u201d in the Blood Donor Educational Material)?<\/td>Y<\/td>N<\/td><\/tr>
13<\/td>Had sexual contact with more than one partner?<\/td>Y<\/td>N<\/td><\/tr>
14<\/td>Had sexual contact with anyone who has ever had a positive test for HIV infection?<\/td>Y<\/td>N<\/td><\/tr>
15<\/td>Received money, drugs, or other payment for sex?<\/td>Y<\/td>N<\/td><\/tr>
16<\/td>Had sexual contact with anyone who has, in the past 3 months, received money, drugs or other payment for sex?<\/td>Y<\/td>N<\/td><\/tr>
17<\/td>Used needles to inject drugs, steroids, or anything not prescribed by your doctor?<\/td>Y<\/td>N<\/td><\/tr>
18<\/td>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?<\/td>Y<\/td>N<\/td><\/tr>
19<\/td>Had syphilis or gonorrhea or been treated for syphilis or gonorrhea?<\/td>Y<\/td>N<\/td><\/tr>
20<\/td>Had sexual contact with a person who has hepatitis?<\/td>Y<\/td>N<\/td><\/tr>
21<\/td>Lived with a person who has hepatitis?<\/td>Y<\/td>N<\/td><\/tr>
22<\/td>Had an accidental needle-stick?<\/td>Y<\/td>N<\/td><\/tr>
23<\/td>Come into contact with someone else\u2019s blood?<\/td>Y<\/td>N<\/td><\/tr>
24<\/td>Had a tattoo?<\/td>Y<\/td>N<\/td><\/tr>
25<\/td>Had ear or body piercing?<\/td>Y<\/td>N<\/td><\/tr>
26<\/td>Had a blood transfusion?<\/td>Y<\/td>N<\/td><\/tr>
27<\/td>Had a transplant such as organ, tissue, or bone marrow?<\/td>Y<\/td>N<\/td><\/tr>
28<\/td>Had a graft such as bone or skin?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

IN THE PAST 16 WEEKS, HAVE YOU<\/strong><\/p>\n\n\n\n

29<\/td>Donated a double unit of red blood cells using an apheresis machine?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

IN THE PAST 12 MONTHS, HAVE YOU<\/strong><\/p>\n\n\n\n

30<\/td>Been in juvenile detention, lockup, jail, or prison for 72 hours or more consecutively?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

IN THE PAST TWO YEARS, HAVE YOU<\/strong><\/p>\n\n\n\n

31<\/td>Received any medication by injection to prevent HIV infection? (i.e., long-acting antiviral PrEP or PEP)<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

IN THE PAST THREE YEARS, HAVE YOU<\/strong><\/p>\n\n\n\n

32<\/td>Been outside the United States or Canada?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

HAVE YOU EVER<\/strong><\/p>\n\n\n\n

33<\/td>Had a positive test for the HIV infection?<\/td>Y<\/td>N<\/td><\/tr>
34<\/td>Taken any medication to treat HIV infection?<\/td>Y<\/td>N<\/td><\/tr>
35<\/td>Been pregnant?<\/td>Y<\/td>N<\/td><\/tr>
36<\/td>Had malaria?<\/td>Y<\/td>N<\/td><\/tr>
37<\/td>Received a dura mater (or brain covering) graft or xenotransplantation product?<\/td>Y<\/td>N<\/td><\/tr>
38<\/td>Had any type of cancer, including leukemia?<\/td>Y<\/td>N<\/td><\/tr>
39<\/td>Had any problems with your heart or lungs?<\/td>Y<\/td>N<\/td><\/tr>
40<\/td>Had a bleeding condition or a blood disease?<\/td>Y<\/td>N<\/td><\/tr>
41<\/td>Had a positive test result for Babesia<\/em>?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

ADDITIONAL QUESTIONS<\/strong><\/p>\n\n\n\n

42<\/td>In the past 28 days, have you traveled outside the United States?<\/td>Y<\/td>N<\/td><\/tr>
43<\/td>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?<\/td>Y<\/td>N<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Additional restrictions may apply. <\/p>\n\n\n\n

\n
Review Common Reasons for Deferral \u2014><\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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\u2122. If you have notifications turned on, you should get a reminder to complete your SBC preCheck\u2122 on the day of your appointment as […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":9,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-597","page","type-page","status-publish","hentry"],"acf":[],"lang":"en","translations":{"en":597,"es":1330},"pll_sync_post":[],"_links":{"self":[{"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/pages\/597","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/comments?post=597"}],"version-history":[{"count":5,"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/pages\/597\/revisions"}],"predecessor-version":[{"id":923,"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/pages\/597\/revisions\/923"}],"wp:attachment":[{"href":"https:\/\/api.stanfordbloodcenter.org\/admin\/wp-json\/wp\/v2\/media?parent=597"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}