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Blood Transfusion Form (NEW)

This blood transfusion form documents the transfer of a blood unit from the blood bank to a patient. It records the patient's name, age, sex, ward, blood type, physician, the blood unit serial number and expiry date. It also documents that compatibility testing showed the blood unit was compatible with the patient's serum, who checked the blood unit appearance, who started and completed the transfusion, removed the transfusion set, and any remarks about reactions during the transfusion.

Uploaded by

Jie Fuentes
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326 views1 page

Blood Transfusion Form (NEW)

This blood transfusion form documents the transfer of a blood unit from the blood bank to a patient. It records the patient's name, age, sex, ward, blood type, physician, the blood unit serial number and expiry date. It also documents that compatibility testing showed the blood unit was compatible with the patient's serum, who checked the blood unit appearance, who started and completed the transfusion, removed the transfusion set, and any remarks about reactions during the transfusion.

Uploaded by

Jie Fuentes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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BLOOD TRANSFUSION FORM

AGE / SEX: ____________ WARD : ___________


NAME: _______________________________
DATE: ________________
Blood TYPE: _______
PHYSICIAN: __________________________
Blood Unit Serial # : _______________________
Expiry Date : _____________________________
Blood Unit Received by :
Unit Blood Type : _________________________
____________________
__________
Issued By : _______________________________
(Name in Print / Signature)
(Date)
Component: ______________________________
Result of Compatible Testing :
Compatible with Patients serum
Appearance of unit checked by: _________________________
Date: ____________
Time: _______
Transfusion started by: ________________________________
Date: ____________
Time: _______
Transfusion completed by: _____________________________
Date: ____________
Time: _______
Transfusion set removed by: ____________________________
Date: ____________
Time: _______
Remarks:
( ) Transfusion completed without immediate transfusion reaction noted
( ) Transfusion stopped with transfusion reaction noted
( ) Fever ( ) Nausea ( ) Flushes ( ) Chills ( ) Vomiting ( ) Rashes ( ) Others
( ) For transfusion studies

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