PPTA Donor History Questionnaire

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The Full-Length PPTA Donor History Questionnaire and Abbreviated Questionnaire are designed to aid plasma sourcing organizations in evaluating a prospective donor’s history relative to current known safety risks, FDA regulations and recommendations, PPTA voluntary standards, and optionally, European requirements. The Full-Length PPTA DHQ is designed as a stand-alone questionnaire that may be used at each donation. It may also be used in conjunction with an abbreviated form for frequent donors.

The following documents are included as part of the PPTA Donor History Questionnaire:

Version 2.0 (July 2016)

The version 2.0 of the questionnaires and accompanying materials have been recognized by the FDA in a Guidance for Industry as an acceptable mechanism for collecting donor history information from Source Plasma donors. The materials are consistent with FDA's requirements and recommendations for collecting Source Plasma donor history information.  For your reference, previous version 1.2 will remain on the website below until we archive later this year.

 

PPTA Donor History Questionnaire:  Version 1.2 (September 2012) 

  • Full-length DHQ (Rev. September 2015 - Donor screening test that does not detect HIV-1 Group O no longer available)

  • Full-length Directions for Use (Q#4 Rev. Sept 2013 - See ABSORICA and ZENATANE; Rev. September 2015 - Donor screening test that does not detect HIV-1 Group O no longer available)

  • Abbreviated DHQ

  • Abbreviated Directions for Use (Q#3 Rev. Sept 2013 - See ABSORICA and ZENATANE; Rev. September 2015 - Donor screening test that does not detect HIV-1 Group O no longer available)

  • Medication List (Rev. Sept 2013 - See ABSORICA and ZENATANE)

  • Posters:
    • Risk Poster (Rev. September 2015 - Donor screening test that does not detect HIV-1 Group O no longer available)
    • Travel Poster (Rev. September 2015 - Donor screening test that does not detect HIV-1 Group O no longer available)
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