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Have you or your partner received non-therapeutic injected drug use within the preceding five years? (Including intravenous, intramuscular, or subcutaneous injection.) *
Have you, within the previous 12 months, been with a heterosexual partner that was HIV positive?*
Have you or your partner had any evidence of HIV infection?*
Have you or your partner been inmates of a correctional facility for 72 consecutive hours or longer within the preceding 12 months?*
Have you in the preceding 12 months had close contact with a person who had clinically active hepatitis (e.g. living in the same household, sharing of kitchen and bathroom facilities)?*
Have you been diagnosed with or been exposed to West Nile Virus within the last month?*
Have you or your partner had a positive test for or treatment for syphilis, gonorrhea or Chlamydia in the past 12 months?*
Do you have a degenerative or infectious neurological disease, such as Creutzfeldt-Jakob disease, multiple sclerosis, Alzheimer’s disease, encephalitis of unknown etiology?*
Have you ever received pituitary derived human growth hormone?*
Are you a current or former U.S. military member, civilian military employee, or dependent of a military or civilian employee who resided at U.S. military bases in Northern Europe (Germany, U.K., Belgium, and the Netherlands) for 6 months or more from 1980 through 1990, or elsewhere in Europe (Greece, Turkey, Spain, Portugal, and Italy) for 6 months or more from 1980 through 1996?*
Have you spent three months or more cumulatively in the UK from the beginning of 1980 through the end of 1996?*
Have you had a transplant or other medical procedure involving exposure to live cells, tissues, or organs from an animal?*
Has an intimate contact of yours had a transplant or other medical procedure involving exposure to live cells, tissues, or organs from an animal? (Sexual partner, sharing of razors, toothbrushes, health care or lab workers with repeated percutaneous, mucosal or other direct exposure.)*
Have you lived cumulatively for 5 years or more in Europe from 1980 until the present (note this criterion includes time spent in the U.K. from 1980 through 1996)?*
Have you received any transfusion of blood or blood components in the U.K. between 1980 and the present?*
Have you received a blood transfusion in the previous 12 months?*
Have you ever had exclusion from a blood donation for reasons of infectious disease?*
Have you or your partner ever had a sexually transmissible disease, including herpes simplex type 2?*
Have you had an occupation with increased risk of radiation or chemical exposure; or known exposure to radiation or chemicals?*
Have you had significant exposure to a substance that may be transferred in toxic doses, such as lead, mercury and/or gold?*
Have you, within the preceding six months, received a bite from an animal suspected of having rabies?*
Do you have a hormone relaeasing IUD?*

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