Human Tissue Act 1983 Regulation relating to the form to be completed by blood donors (1992-37) [GG No 12 of 24.1.1992] (NSW)

1992—No. 37

HUMAN TISSUE ACT 1983—REGULATION

(Relating to the form to be completed by blood donors)

NEW SOUTH WALES

[Published in Gazette No. 12 of 24 January 1992]

HIS Excellency the Governor, with the advice of the Executive Council, and in pursuance of the Human Tissue Act 1983, has been pleased to make the Regulation set forth hereunder.

J. P. HANNAFORD

Minister for Health and Community Services.

Commencement

1. This Regulation commences on 28 January 1992.

Amendment

2. Schedule 1 to the Human Tissue Regulation 1984 is amended by

omitting Part A of Form 3 and by inserting instead the following Part:

*PART A—CERTIFICATE BY PERSON DONATING

BLOOD

BEFORE YOU GIVE BLOOD

There are some people in the community who MUST NOT donate
blood because it may transmit infections to patients who receive it.

You must complete this form if you want to donate blood. If you do not know how to answer any of the questions, please check with the interviewing sister. It is against the law to knowingly make a false or misleading statement. If you do, you may receive a $5,000 fine or 1 year in prison.

1992—No. 37

TO THE BEST OF MY KNOWLEDGE MY ANSWERS TO

THE FOLLOWING QUESTIONS ARE TRUE

1.    Have you any reason to believe that:

you have AIDS (Acquired Immune

Deficiency Syndrome)?	Yes	No
you have been infected with the
virus that causes AIDS (HIV)?	Yes	No

2.    In the last 6 months have you had:

night sweats?	Yes	No
unexplained weight loss?	Yes	No
persistent	fever?	Yes No
diarrhoea?	Yes No

swollen glands? Yes No

3.    Have you had male to male sexual activity

since 1977? Yes No

4.    Have you had sexual activity with a

bisexual male since 1977? Yes No
5 .	Have you had sexual activity with any person who may have been exposed to the virus that causes AIDS (HIV)? Yes No

6 .    Have you EVER injected yourself, or been injected with, any drug not prescribed by a doctor? Yes No

7.    Have you EVER shared drug needles? Yes No

8.    Have you been accidentally stuck with a

used needle in the last 12 months? Yes No

9.    Have you EVER been a male or female

prostitute? Yes No

10.   Have you had sexual activity with a male

or female prostitute in the last 12 months? Yes No

11.    Have you been tattooed within the last 12

months? Yes No

12.    Have you received a blood transfusion or treatment with human blood products in the last 12 months? Yes No

13.    In the last 2 years have you had jaundice or

hepatitis, or been in close contact with any

person with either of these illnesses? Yes No

14.   Are the answers to questions 1–13 also

correct for your present and past spouse(s)

and present and past sexual partner(s)? Yes No

1992—No. 37

Please do not sign the form yet.

Take it with you to the interviewing sister.

Signature of Donor ......................................

Name (PRINT) ..........................................

Signature of Witness .................................

Name (PRINT) ..........................................

DATE ........................................................

EXPLANATORY NOTE

The purpose of this regulation is to amend the Human Tissue Regulation 1984 to substitute the form to be completed by blood donors. The new form takes account of present knowledge of HIV/AIDS transmission and is in plainer English than the existing form.