Download CIR 15-HV-013 Additional Blood Donations Form

MRC / University of Edinburgh Centre for Inflammation Research,
Queen’s Medical Research Institute, C2.29
47 Little France Crescent,
Edinburgh EH16 4TJ,
Scotland, UK
Tel: 0131 242 6582
Centre for Inflammation Research Blood Resource
ADDITIONAL BLOOD DONATIONS FORM
STUDY TITLE: THE ROLE OF INFLAMMATION IN HUMAN IMMUNITY
AMREC Reference number 15-HV-013
This form should be used by a researcher when a participant in the above
study has reported having donated blood:
a) for any reason in the 12 months before their first blood donation to the
study, or
b) for any reason other than this study in the period since their last
donation to this study.
In this event, this form must be completed and returned to the Projects
Administrator Sonia Rafferty (Room C2.29, QMRI, [email protected] ),
who will then add this information to the Donor Database. A blood donation
must not be taken from this participant until their eligibility on the Donor
Database can be rechecked after this information has been entered.
The participant is not required to explain the nature of any blood donations,
but these may, for example, be for another study, relate to a health issue, or
be to donation to the Blood Transfusion service.
Researcher Name:
Donor Name:
Additional blood donations:
Approximate Date
Approximate Volume
Approximate Date
Approximate Volume
Approximate Date
Approximate Volume
Approximate Date
Approximate Volume
Approximate Date
Approximate Volume
Approximate Date
Approximate Volume
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additional blood donations v1.1
29th June 2016