Health (Infectious Diseases) (Donation Statement) Regulations 1999 (Vic)

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

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NOTES 5

i

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 19901 substitute—

Health (Infectious Diseases) (Donation Statement) Regulations
1999

r. 3	S.	R. No. 108/1999
"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, 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:

Health (Infectious Diseases) (Donation Statement) Regulations

1999

S.R. No. 108/1999 r. 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:

Health (Infectious Diseases) (Donation Statement) Regulations

1999

r. 3 S.R. No. 108/1999

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.".

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Health (Infectious Diseases) (Donation Statement) Regulations
1999

S.R. No. 108/1999 Notes

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.