Physician Evaluation Form for Syphilis

During standard donor infectious disease testing following blood collection, donors who test positive by screening and confirmatory test(s) for syphilis are indefinitely deferred from blood donation. To assess a donor's eligibility for future blood donations, a healthcare provider is required to submit subsequent medical evaluation information, including but not limited to, any known history of syphilis, any diagnostics testing performed (if deemed necessary), and/or treatment of syphilis.