Medical history |
History of hereditary disease |
History of hemophilia or other coagulation disorders who have received human-derived clotting factor concentrates |
Exposure within the last 12 months to blood known or suspected to be infected with HIV, hepatitis B, and/or hepatitis C virus |
Treatment for syphilis, gonorrhea, or chlamydia within last 12 months |
Risk for or family history of transmissible spongiform encephalopathy |
Recent West Nile viral infection |
Acute SARS infection or risk factors for SARS infection |
History of xenotransplant or close contact with xenotransplant patient |
History of human organ or tissue transplant or human extracts |
Recent smallpox vaccination |
Social history |
Injected drug use for nonmedical reasons in last 5 years |
Engagement in casual sexual relations frequently with different partners |
Participation in sex in exchange for money or drugs in the last 5 years |
History of incarceration in jail for more than 72 h in the last 12 months |
Living with another person with viral hepatitis within last 12 months |
Acupuncture, body piercing, or tattooing procedures within the last 12 months in which sterile procedures were not or suspected to be not used |
Sexual intercourse in the last 12 months with persons with any of the above medical or social history |