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This form contains filling fields and may be completed electronically AUTOLOGOUS BLOOD STORAGE ORDER FORM Special Collections 1021 112th Ave NE Bellevue, WA 98004 (800) 2664033 or (425) 4535098 Fax
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How to fill out autologous blood storage order

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How to fill out autologous blood storage order:

01
Start by gathering all the necessary information. This includes the patient's name, date of birth, and contact information. Additionally, make sure you have the physician's name and contact information as well.
02
Specify the blood type and any specific components needed, such as red blood cells or platelets. If unsure, consult with the physician for guidance.
03
Indicate the quantity of blood units required for storage. This will depend on the upcoming procedure or surgeries that the patient may undergo.
04
Include any special instructions or preferences for the storage of the autologous blood. For example, specify if the blood should be frozen or maintained at a certain temperature.
05
Provide any additional required information, such as the scheduled date of the procedure or surgery that the stored blood will be used for.
06
Ensure that the form is signed and dated by the ordering physician.

Who needs autologous blood storage order:

01
Patients who anticipate undergoing surgery or procedures in the future and may require blood transfusions can benefit from an autologous blood storage order.
02
Individuals with specific medical conditions that may increase the likelihood of needing a blood transfusion during or after a procedure may also need an autologous blood storage order.
03
Autologous blood storage order is often recommended for patients with religious or personal beliefs that restrict them from receiving blood from others. This allows them to have their blood available for transfusion.
Note: It is essential to consult with a healthcare professional to determine if an autologous blood storage order is necessary and appropriate for a particular patient's situation.
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Autologous blood storage order is a request made by a patient to store their own blood for future use.
The patient or their legal guardian is required to file the autologous blood storage order.
The autologous blood storage order can be filled out by providing personal information, medical history, and specific instructions for the storage of the blood.
The purpose of autologous blood storage order is to ensure that the patient has access to their own blood in case of a medical emergency.
The autologous blood storage order must include the patient's name, date of birth, medical history, and any specific instructions for the storage of the blood.
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