Blood Donor's Consent for Ages 16 and 17
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PHILIPPINE RED CROSS Rizal Chapter San Juan City Branch
BLOOD DONOR'S CONSENT FOR AGES 16 AND 17
Date: ______
“I am voluntarily giving my blood through the Philippine Red Cross, without remuneration, for the use of persons in need of this vital fluid without regard to rank, color, creed, religion or political persuasion. I understand that all the questions are pertinent for my safety and for the benefits of the patient who will undergo blood transfusion. I understand that my blood will be screened for Malaria, Syphilis, Hepatitis B, Hepatitis C and HIV.
I authorize the Red Cross to dispose of my donated blood in anyway it may deem advisable for the benefit of suffering humanity. I certify that I, to the best of my knowledge, will truthfully answer all the questions in the Donor Interview Sheet.”
“I, as parent/guardian allow my son/ daughter, ______to donate blood.
______Name and Signature of Donor Name and Signature of Parent/Guardian
BO-004 ______
PHILIPPINE RED CROSS Rizal Chapter San Juan City Branch
BLOOD DONOR'S CONSENT FOR AGES 16 AND 17
Date: ______
“I am voluntarily giving my blood through the Philippine Red Cross, without remuneration, for the use of persons in need of this vital fluid without regard to rank, color, creed, religion or political persuasion. I understand that all the questions are pertinent for my safety and for the benefits of the patient who will undergo blood transfusion. I understand that my blood will be screened for Malaria, Syphilis, Hepatitis B, Hepatitis C and HIV.
I authorize the Red Cross to dispose of my donated blood in anyway it may deem advisable for the benefit of suffering humanity. I certify that I, to the best of my knowledge, will truthfully answer all the questions in the Donor Interview Sheet.”
“I, as parent/guardian allow my son/ daughter, ______to donate blood.
______Name and Signature of Donor Name and Signature of Parent/Guardian BO-004