ASBBC Form 044 – Fill Out and Use This PDF

ASBBC Form 044 PDF Details

The ASBBC Form 044 serves a critical health screening purpose: it assesses whether a blood donor's travel history disqualifies them from safely donating blood through the Armed Services Blood Bank Center. The form was revised in October 2010 and is issued by the ASBBC located in Bethesda, MD.

The document spans two pages. It begins by requesting personal identifiers including the donor's full name and Social Security Number, which protect individual privacy in accordance with the DD Form 572 Privacy Act Statement.

The form then walks through a structured series of travel history questions organized by geographic region and risk level:

• United Kingdom (1980–1996): Cumulative time spent in the UK during these years is a key screening factor because of the elevated BSE risk during that period.
• European travel: Time in Eastern or Western Europe is also evaluated, as BSE was documented across multiple countries during the 1980s and 1990s.
• Middle East and certain African countries: Regions with documented BSE prevalence are included in the health risk assessment.
• Republic of Korea: The form addresses recent travel to Korea and probes further based on the duration and specific locations visited.

Each section uses checkboxes to streamline data collection and reduce interviewer errors. The structured format allows health services staff to quickly identify whether a donor's travel profile requires further review or disqualification.

This diligence in gathering travel data reflects the ASBBC's commitment to maintaining high safety standards. Every blood donation collected by the Armed Services Blood Program must meet strict eligibility criteria, and the ASBBC Form 044 is a key tool in that process. Related military health forms include the DD Form 149 and the Blood Donation Questionnaire (UK).