Health (Infectious Diseases) (Donation Statement) Regulations 1999

i Health (Infectious Diseases) (Donation Statement) Regulations 1999 S.R. No. 108/1999 TABLE OF PROVISIONS Regulation Page 1. Objective 1 2. Authorising provisions 1 3. New Schedule 6 substituted 1 SCHEDULE 6—Blood donation statement 2 ═══════════════ NOTES 5 -- 1 of 6 -- 1 STATUTORY RULES 1999 S.R. No. 108/1999 Health Act 1958 Health (Infectious Diseases) (Donation Statement) Regulations 1999 The Governor in Council makes the following Regulations: Dated: 17 August 1999 Responsible Minister: ROB KNOWLES Minister for Health SHANNON DELLAMARTA Acting Clerk of the Executive Council 1. Objective The objective of these Regulations is to prescribe a new statement to be obtained from blood donors. 2. Authorising provisions These regulations are made under sections 146, 390(1) and 391(1) of the Health Act 1958. 3. New Schedule 6 substituted For Schedule 6 to the Health (Infectious Diseases) Regulations 1990 1 substitute— -- 2 of 6 -- S.R. No. 108/1999 Health (Infectious Diseases) (Donation Statement) Regulations 1999 2 "SCHEDULE 6 Regulation 20 HEALTH (INFECTIOUS DISEASES) REGULATIONS 1990 BLOOD DONATION STATEMENT There are some people in the community who MUST NOT give blood as it may transmit infections to people who receive it. So before you give blood you need to answer some questions to ensure that it will be safe for people to be given your blood or blood products. The following questions are a vital part of the effort to eliminate these diseases from the blood supply. Even though there are a lot of questions they are all important and you need to answer every question on the form honestly and to the best of your ability. Answering these questions honestly is important because there are severe penalties including fines and imprisonment for making a false statement. All donations of blood are tested for the presence of Hepatitis B and C, HIV 1 and 2 (AIDS virus), syphilis, and HTLV I and II. Should your blood test positive for any of these diseases or show a significantly abnormal result you will be notified. To the best of your knowledge have you: (please circle your answer) 1. In the last 6 months had an illness with swollen glands and a rash, with or without a fever? YES NO 2. Ever thought you could be infected with HIV or have AIDS? YES NO 3. Ever "used drugs" by injection or been injected, even once, with drugs not prescribed by a doctor or dentist? YES NO 4. Ever had treatment with clotting factors such as Factor VIII or Factor IX? YES NO 5. Ever had a test which showed you had Hepatitis C or HIV? YES NO 6. In the last 12 months have you engaged in sexual activity with someone you might think would answer "yes" to any of questions (1–5)? YES NO 7. Since your last donation or in the last 12 months have you had sexual activity with a new partner who currently lives or has previously lived overseas? YES NO Within the last 12 months have you: r. 3 -- 3 of 6 -- S.R. No. 108/1999 Health (Infectious Diseases) (Donation Statement) Regulations 1999 3 (please circle your answer) 8. Had male to male sex? YES NO 9. Had sexual activity with a male who you think might be bisexual? YES NO 10. Been a male or female sex worker (eg received payment for sex in money, gifts or drugs)? YES NO 11. Engaged in sexual activity with a male or female sex worker? YES NO 12. Been injured with a used needle (needlestick)? YES NO 13. Had a blood/body fluid splash to eyes, mouth, nose or to broken skin? YES NO 14. Had a tattoo (including cosmetic tattooing), skin piercing, electrolysis or acupuncture? YES NO 15. Been imprisoned in a prison or lock-up? YES NO 16. Had a blood transfusion? YES NO 17. Had (yellow) jaundice or hepatitis or been in contact with someone who has? YES NO Thank you for answering these questions. If you are uncertain about the answers to these questions please discuss this with the interviewer. We would like you to sign this declaration in the presence of a Blood Service staff member. ! I declare that I have understood the information on the form and answered the questions in the statement to the best of my knowledge. ! I understand that, as scientific knowledge advances, I may be asked by the Blood Service to undergo further blood tests. ! I understand that my donation is a gift to the Blood Service which may be used for therapeutic purposes and in some instances for the manufacture of diagnostic agents and research. ! I have been advised that there are some possible risks associated with donating blood. I have also been informed that I must follow the instructions of the Blood Service staff to minimise these risks. Donor's signature: Witness signature: r. 3 -- 4 of 6 -- S.R. No. 108/1999 Health (Infectious Diseases) (Donation Statement) Regulations 1999 4 Print name: Print name: Date: Please notify the blood service if you become unwell within 5 days of donating. Even if you are unable to give blood today we thank you for coming and appreciate your willingness to be a blood donor.". ═══════════════ r. 3 -- 5 of 6 -- S.R. No. 108/1999 Health (Infectious Diseases) (Donation Statement) Regulations 1999 5 NOTES 1 Reg. 3: S.R. No. 85/1990. Reprinted to S.R. No. 232/1993 and subsequently amended by S.R. Nos 142/1994, 93/1996, 57/1998 and 133/1998. Notes -- 6 of 6 --