19b. Did she/he* live with a person who No had? 19b(i). Who was it? Yes 20. Did she/he* EVER have a positive or reactive test for: 20a. tuberculosis, such as a positive skin No or blood test? Yes 20a(i). Explain: the HIV/AIDS virus? No 20b. Yes 20b(i). Explain: 20c. hepatitis? No Yes 20c(i). Explain: No 20d. HTLV-I or HTLV-II? Yes 20d(i). Explain: 20e. T. cruzi or told she/he* has Chagas’ No disease? Yes 20e(i). Explain: Did she/he* have liver disease or 21. EVER No hepatitis? Yes 21a. What kind? 21b. When? 22. Did she/he* EVER have malaria? No Yes
19b. Did she/he* live with a person who had? No Yes 19b(i). Who was it? 20. Did she/he* EVER have a positive or reactive test for: 20a. tuberculosis, such as a positive skin or blood test? 20b. the HIV/AIDS virus? 20c. hepatitis? 20d. HTLV-I or HTLV-II? 20e. T. cruzi or told she/he* has Chagas’ disease? No Yes No Yes No Yes No Yes No Yes 20a(i). Explain: 20b(i). Explain: 20c(i). Explain: 20d(i). Explain: 20e(i). Explain: 21. Did she/he* EVER have liver disease or hepatitis? No Yes 21a. What kind? 21b. When? 22. Did she/he* EVER have malaria? No Yes
Uniform%20DRAI%20-%20Child%20Donor%20less%20than%20or%20equal%20to%2012%20yrs%20old%2010-20-14.docx