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REQUEST FOR AUTOLOGOUS DONOR BLOOD COMPONENTS (Note this is a 2-page form; both pages are required!) Schedule appointment for all donor centers and auto van by Faxing orders to 909.386.6817 Call Toll
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How to fill out request for autologous donor
How to fill out a request for autologous donor:
01
Gather necessary information: Start by gathering the necessary information for the request. This usually includes the patient's name, date of birth, medical record number, and any specific details about the procedure or treatment for which the autologous donor is needed.
02
Complete the donor request form: Use the provided donor request form to fill out the required information. This form typically includes sections for the patient's personal information, medical history, and specific details about the autologous donor.
03
Provide medical documentation: Attach any relevant medical documentation or records that support the need for an autologous donor. This may include physician's notes, test results, or previous medical procedures.
04
Include contact information: Ensure that the request form includes up-to-date contact information for both the patient and the healthcare provider. This will allow for efficient communication and follow-up regarding the request.
05
Submit the request: Once the request form is filled out and all required information is provided, submit it to the appropriate department or healthcare provider responsible for handling autologous donor requests.
Who needs a request for autologous donor?
01
Patients undergoing specific medical procedures: A request for an autologous donor may be needed for patients undergoing surgeries or treatments that require blood or other tissue transfusions. It is typically used when the patient's own blood or tissue needs to be collected and stored for later use in the procedure.
02
Individuals with certain medical conditions: Patients with certain medical conditions, such as cancer or blood disorders, may require autologous donors for various treatments. These requests ensure that the patient receives safe and compatible blood or tissue products during their treatment.
03
Healthcare providers and medical professionals: Healthcare providers and medical professionals involved in a patient's care may also need to submit a request for an autologous donor. This helps facilitate the process of collecting and preparing the patient's own blood or tissue for use in the procedure or treatment.
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What is request for autologous donor?
A request for an autologous donor is a formal application to use the patient's own tissues or cells for a medical procedure.
Who is required to file request for autologous donor?
The healthcare provider or medical facility performing the procedure is required to file a request for an autologous donor.
How to fill out request for autologous donor?
The request for an autologous donor must include information about the patient's medical history, the specific tissues or cells to be used, and the proposed medical procedure.
What is the purpose of request for autologous donor?
The purpose of a request for an autologous donor is to obtain approval to use the patient's own tissues or cells for a medical procedure, in order to avoid complications from tissue rejection.
What information must be reported on request for autologous donor?
The request for an autologous donor must include the patient's medical history, details of the proposed medical procedure, and any risks or complications associated with using the patient's own tissues.
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