Allogeneic (Public) Donation Pre-Registration
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Yes
No
Are you pregnant with more than one child?
Yes
No
Were you or the baby's father adopted at early childhood without medical history available?
Yes
No
Have you, the baby's father, or any of the baby's siblings had cancer or leukemia?
Yes
No
Do you have a blood disorder such as Factor V Leiden?
Yes
No
Do you or the baby's father have HIV/AIDS or a diagnosed Auto-Immune Disorder (Rheumatoid Arthritis, Crohn's Disease, Lupus, MS)?
Yes
No
Do you have positive Hepatitis B surface antigens, or Hepatitis C? Do you have other history of Hepatitis including positive screening tests for Hepatitis after the age of 11?
Yes
No
Have you have received a heart, lung, kidney, bone marrow, or other organ or tissue transplant?
