SLV Health Blood Drive Friday, October 21 st From 10:30 a.m. until 2:30 p.m. Held at the SLV health Conference Center at 1921 Main To schedule your appointment, please contact Jho Cura at (719) 587-1226 or jhoanna.cura@slvrmc.org OR Mary Rice at (719) 587-1225 or mary.rice@slvrmc.org Walk-in s are welcome and will be worked in around scheduled appointments. Please eat a hearty meal and drink lots of water before you donate blood! Did you know that 30 percent of people don't show up to their blood donation appointment? We are counting on you to help us prevent shortages in the blood supply by honoring your appointment to give blood. Bonfils Blood Center 717 Yosemite Street, Denver, CO 80230 Contact Us 303.341.4000, opt. 3 800.365.0006, opt. 3
Donor Prescreening Questions CDO-384-PRD REV 19 Please read the following in its entirety to help guarantee your safety and the safety of the community blood supply and to help ensure you have a positive donation experience. Bonfils recommends that prior to your donation you eat within 2 hours and hydrate for 24-48 hours. If you would like something to eat or drink before your donation please help yourself to the items in the canteen area. Donors are commonly deferred for the following questions. Bonfils asks these prescreening questions so donors do not spend time answering our full questionnaire only to find they are ineligible for a common reason. Even if you answer no to all of these prescreening questions, you may be ineligible to donate based on the answers given during the full questionnaire and interview process completed just prior to the actual donation. If you answer yes to any of these questions on the day you present to donate, you will NOT be eligible to donate at that time. If you have any questions related to travel or your eligibility to donate as a whole contact Bonfils Donor Relations department at 303.363.2202 or 800.365.0006, opt. 1 or ask a Bonfils staff member at the time of your donation. HEALTH STATUS AND AGE 1. Do you weigh less than 110 pounds or more than 350 pounds? 2. Are you 15 years or younger? 3. Are you ill or not feeling well today? 4. Have you ever been diagnosed with lymphoma and/or leukemia? MEDICATIONS 5. Are you taking antibiotics today for an active infection? 6. Have you taken Accutane, Proscar or Propecia in the last month? 7. Have you taken Coumadin/Warfarin in the last 7 days? TATTOOS AND PIERCINGS 8. Have you received a tattoo that was not performed in a doctor s office in the last 12 months?* 9. Have you received an ear or body piercing that was not performed with single-use equipment in the last 12 months?* TRAVEL AND RESIDENCE ABROAD 10. From 1980 through 1990 were you in Belgium, Germany, the Netherlands or Holland as a member of the U.S. military, a civilian military employee or a dependent of a member of the U.S. military for 6 months or more?* 11. From 1980 through 1996 were you in Spain, Portugal, Turkey, Italy, Sicily or Greece as a member of the U.S. military, a civilian military employee or a dependent of a member of the U.S. military for 6 months or more?* 12. From 1980 to present have you spent time that adds up to 5 years or more in Europe?* 13. In the past 12 months have you spent more than 24 hours in (traveled to) any individual location outside of the U.S. or Canada?* a. If yes, did you travel to any of the countries or cities listed as a malarial risk area on the table on the back of this page? There are many ways to save lives with Bonfils. You can also help through Bonfils marrow program and volunteer opportunities. *Additionally, if you are deferred for these categories, you may still be eligible for research donations. Visit bonfils.org to learn more. PG 1 OF 2 Please call Bonfils Donor Relations department at 303.363.2202 or 800.365.0006, opt. 1 for complete information on donor eligibility.
The table below is referenced in prescreening question 13a. Like the prescreening questions on this document that reference common deferrals but not all deferrals, this table includes common malarial risk areas but it is not an all-inclusive list. AFGHANISTAN CAMBODIA HAITI NICARAGUA AFRICA Angola Botswana Burundi Cameroon Central African Republic Chad Congo Ethiopia Gabon Gambia Ghana Ivory Coast Kenya Liberia Mozambique Niger Nigeria Rwanda Senegal Sierra Leone Somalia Sudan Tanzania Uganda Zaire Zambia Zimbabwe CHINA Dali Banna Chuxiong City Dian Lake Jade Dragon Snow Mountain Jinghong Kunming Lijiang Nansha New Yuanyang Old Yunanyang Panzhihua Shangri-la Shilin Stone Forest Tiger Leaping Gorge Xinje Yunnan COLOMBIA Any area outside Bogota or Cartegena DOMINICAN REPUBLIC Any area outside Santiago or Santo Domingo HONDURAS Any area outside San Pedro Sula or Tegucigalpa (including the Bay Islands) INDIA INDONESIA IRAN MALAYSIA MEXICO Chihuahua City Copper Canyon Durango El Fuerte Hidalgo del Parral Los Mochis Mazatlan Nuevo Mazatlan Nuevo Vallarta Punta Mita Sayulita PANAMA Any area east of the Panama Canal including the region of Colon SOUTH KOREA Any area north of Seoul, including the Demilitarized Zone (DMZ) VIETNAM Please call Bonfils Donor Relations department at 303.363.2202 or 800.365.0006, opt. 1 for complete information on donor eligibility. PG 2 OF 2
Zika Virus: Notice to Travelers & Educational Material These are the areas where Zika is present. Do NOT donate blood for 28 days after returning from any of these places. UNITED STATES Florida: Miami-Dade & Palm Beach Counties CENTRAL AMERICA Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama SOUTH AMERICA Argentina Bolivia Brazil Chile Colombia Ecuador Falkland, South Georgia & South Sandwich Islands (UK) French Guiana Guyana Paraguay Peru Suriname Uruguay Venezuela ATLANTIC & PACIFIC ISLANDS American Samoa Cape Verde Federated States of Micronesia Fiji Marshall Islands New Caledonia Papua New Guinea Samoa Tonga MEXICO All Locations SINGAPORE All Locations CARIBBEAN Anguilla (UK) Antigua & Barbuda Aruba (Netherlands) Bahamas Barbados Bermuda Bonaire (Netherlands) British Virgin Islands (UK) Cayman Islands (UK) Cuba Curaçao (Netherlands) Dominica Dominican Republic Grenada Guadeloupe (France) Haiti Jamaica Martinique (France) Montserrat (UK) Puerto Rico (US) Saba (Netherlands) Saint Barthélemy (France Saint Kitts & Nevis Saint Lucia Saint Martin (France) Saint Vincent & the Grenadines Sint Eustatius (Netherlands) Sint Maarten (Netherlands) Trinidad & Tobago Turks & Caicos Islands (UK) United States Virgin Islands (US) Please see reverse for important additional information August 31, 2016 Page 1 of 2 CDO-VC-38 rev 11
Zika Virus: Notice to Travelers & Educational Material The United States, Mexico, the Caribbean, Central and South America, Singapore, American Samoa, Samoa, Tonga, and Cape Verde Islands What is Zika? Zika is a virus carried by mosquitos. Zika virus causes symptoms of: Fever Rash Joint or muscle pain Eye pain or redness Headache How is Zika transmitted? Through bite of an infected mosquito From a pregnant mother to her baby Through sexual contact Possibly by blood transfusion You should NOT donate today if in the PAST 4 WEEKS: You have been in an area where Zika is present (see the current list on other side) You had symptoms from a known case of Zika You have had two or more symptoms listed above following recent travel (within 2 weeks) to an area where Zika is present (see list) You have had sexual contact with a man who: Had a known case of Zika in the past 3 months Has been in an area where Zika is present in the past 3 months (see list) Important Post Donation Information: Certain illnesses can be transmitted to patients through blood transfusion from an infected donor. These illnesses include those contracted while traveling abroad (such as Zika, dengue, chikungunya, and malaria) or domestically (such as West Nile virus and influenza). Although you feel well and healthy at the time of your donation, please call us immediately at the phone number beside our blood center s name below if you develop two or more of the following symptoms within 14 days of your blood donation. Fever Rash Muscle or joint Eye pain or Headache pain redness By notifying us as soon as possible after developing any of these symptoms you may prevent the blood you donated today from being transfused and possibly infecting a patient. NOTE: If you recall being potentially at risk for Zika exposure (refer to criteria above) in the past 4 weeks, please call us. Although you are feeling well, you could be infected with Zika Bonfils Blood Center www.bonfils.org 303-363-2202 August 31, 2016 Page 2 of 2 CDO-VC-38 rev 11