I hereby request that The Blood Connection draw directed donors for the
patient named in this order. I understand that directed donations are not
accepted on an emergent basis. This request will be reviewed and coordinated
by our Special Donations Coordinator. We will call the patient to obtain
the information for their anticipated donor and schedule their donations.
All donations must be scheduled ahead of time to ensure accurate and timely
service. We do not accept walk-ins. Please allow up to 3 business days
for this request to be processed.
I understand that it is the responsibility of the patient for whom I have
requested these donations to ensure the donors present themselves to The
Blood Connection not less than five working days prior to the intended
date of use. It is the responsibility of the patient and the patient’s
physician to ensure that all patient information is correct and to notify
The Blood Connection if the date of intended use is changed.
I understand that blood from donors may not be available if:
- Donor does not meet The Blood Connection’s eligibility requirements
- Donor’s blood type is not compatible (donor’s blood type
must be verified before unit can be drawn)
- Donor is rejected by screening tests
-If the units collected are broken, compromised, contaminated, or not
transfusable for any reason.
The Blood Connection cannot guarantee that directed donation units will
be available for use or transfused, if a transfusion is required. All Blood
donated at The Blood Connection is property of The Blood Connection. The
Blood Connection will take reasonable measures to deliver directed donation
units to the hospital within the time specified after timely notice. Additional
products needed after the intended transfusion/surgery date selected on
this form will require a new order.
The receiving hospital will be charged and will pay for all processing/service
fees associated with for the collection of the directed blood units whether
or not they are compatible or transfused.