Get the free Living Donor Health History - ucdmc ucdavis
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This form is designed to collect health history and personal information from individuals considering living organ donation at UC Davis Transplant Center.
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How to fill out living donor health history
How to fill out Living Donor Health History
01
Start with your personal information: Provide your full name, date of birth, and contact details.
02
Complete the medical history section: Include any past surgeries, chronic illnesses, or ongoing treatments.
03
Fill out family medical history: List any hereditary health issues in your family.
04
Answer questions about lifestyle habits: Indicate if you smoke, use alcohol, or have recreational drug use.
05
Provide information about medications: List any prescription or over-the-counter medications you are currently taking.
06
Review and verify all information: Make sure all entries are accurate and complete.
07
Sign and date the form to certify all information provided is true.
Who needs Living Donor Health History?
01
Individuals who wish to become living organ donors must complete the Living Donor Health History.
02
Medical professionals who assess the donor's health prior to the donation process.
03
Transplant centers that require a thorough health history for their records and evaluation.
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What is Living Donor Health History?
Living Donor Health History is a comprehensive documentation of a living donor's medical and health background to assess their eligibility for organ donation.
Who is required to file Living Donor Health History?
The living donor themselves is required to file Living Donor Health History as part of the evaluation process before donation.
How to fill out Living Donor Health History?
To fill out Living Donor Health History, the donor needs to provide detailed information about their medical history, current medications, lifestyle habits, and any significant family health issues.
What is the purpose of Living Donor Health History?
The purpose of Living Donor Health History is to ensure the safety and suitability of the donor for organ transplantation, identifying any potential health risks.
What information must be reported on Living Donor Health History?
The information that must be reported includes the donor's medical history, current health status, medications, allergies, lifestyle factors, and family medical history.
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