Printable Forms for California Central Coast and
Community Blood Bank of Rancho Mirage
These are the forms currently available online. Click on the link to download a PDF of the form. If you do not see the form you need or the link is inactive, contact your local blood center. Customers in locations outside of California click here for a list of forms. |
Transfer Document form for Couriers (SafeTrace Shipping Document or HSF005, available from your blood center representative) – This form is used to document the shipment of blood components.
Reference Laboratory Request Form (BS 313 for antibody reference work. All other requests use LAF022, available from your blood center representative) – This form is used to request testing through the immunohematology reference laboratory.
Report of Transfusion Associated Infection form (BS 314) – This form is used to report all clinically significant infections or infectious diseases in recipients of blood products that could have resulted from transfusion and for which another, more likely, cause is not apparent.
Credit Request form – To request credit for non-usable or damaged blood components destroyed contact your blood center representative.
Emergency Release Document (34-L82A) – This form is used when blood components (including autologous) are to be released prior to completion of laboratory testing required by the FDA. Emergency Release for Autologous use form 34-L42B.
Special Collections-Autologous Form (34-N21) –This form is used to document a physician’s request for an autologous donation or a therapeutic whole blood collection. For directed donation requests you should contact your blood center representative.
Report of Transfusion Adverse Reaction form (BS 962) – This form is used to report all transfusion adverse reactions which occur in blood or blood component recipients when the reaction is suspected to be due to an attribute specific to the donor or the processing of the blood product.
Inspection Checklist for products stored at 20-24°C (BS 983A)
Inspection Checklist for refrigerated storage units (BS 983B)
Inspection Checklist for frozen component storage (BS 983C)