29b. hepatitis? No 29b(i). Explain: Yes 29c. HTLV-I or HTLV-II? No 29c(i). Explain: Yes 29d. T. cruzi or told she/he* has Chagas’ No disease? 29d(i). Explain: Yes 30. Did she/he* EVER have disease or No hepatitis? Yes 30a. What kind? 30b. When? 31. Did she/he* EVER have malaria? No Yes 31a. When? 31b. Where was she/he* treated? 32. Did she/he* EVER have cancer? No Yes 32a. What type? If skin cancer: 32a(i). What kind? 32b. When was it diagnosed?
29b. hepatitis? 29c. HTLV-I or HTLV-II? 29d. T. cruzi or told she/he* has Chagas’ disease? No Yes No Yes No Yes 29b(i). Explain: 29c(i). Explain: 29d(i). Explain: 30. Did she/he* EVER have disease or hepatitis? No Yes 30a. What kind? 30b. When? 31. Did she/he* EVER have malaria? No Yes 31a. When? 31b. Where was she/he* treated? 32. Did she/he* EVER have cancer? No Yes 32a. What type? If skin cancer: 32a(i). What kind? 32b. When was it diagnosed?
Uniform%20DRAI%20-%20Donor%20greater%20than%2012%20yrs%20old%209-10-14.docx