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Convalescent Plasma COVID-19 Donor Request Form

Thank you for your interest in convalescent plasma donation and JOINING OUR FIGHT TO SAVE LIVES.

While COVID has no proven treatment, it is possible that plasma taken from those who have recovered (convalescent plasma), which has antibodies against the virus, could help.

Please submit the form below if you meet the following criteria:

  1. Lab confirmed positive test for COVID-19 (documentation of positive test is required)
    Postive test can be a nasopharyngeal swab or blood antibody test for COVID-19.
  2. Your symptoms have been gone for 14 days
  3. You are willing to donate plasma (donate up to 3 times)

All information provided will be kept confidential and will only be used to qualify you as a donor.

IMPORTANT REMINDERS:

  • Documentation of a positive test is required to donate. Postive test can be a nasopharyngeal swab or blood antibody test for COVID-19. RIBC does not have access to COVID-19 results. The potential donor must have these results before RIBC can make an appointment.
    • Visit How to Obtain A COVID-19 Test Result For Your Patient to obtain a patient’s coronavirus disease 2019 (COVID-19) test result.
    • Patients who were tested at CVS can call the MinuteClinic Patient Support call center (866-389-2727) to get a new copy of the After Visit Summary.
  • Documentation must include your full name, testing facility or physician, and date of test.
  • When presenting to donate, donors are asked to bring a face mask or face covering.

 

CP Donor Registration Form:

* Required fields

DOCUMENTATION OF A POSITIVE TEST (EITHER NASAL SWAB OR BLOOD ANTIBODY) IS REQUIRED TO DONATE.

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DOCUMENTATION MUST INCLUDE YOUR FULL NAME, TESTING FACILITY OR MD, AND DATE OF TEST.

COVID-19 SYMPTOMS INCLUDE FEVER, COUGH, FATIGUE AND SHORTNESS OF BREATH

mm/dd/yyyy

mm/dd/yyyy

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xxx-xxx-xxxx