Queensland Milk Bank Donor Screening and Consent
The purpose of this screening test is to identify donors. We need to ask the questions to ensure that your breast milk is safe for the preterm or sick babies. There is some breast milk that the Queensland Milk Bank may not be able to accept and this will be discussed with you. The Queensland Milk Bank staff will be in touch to discuss during business hours.
By submitting this form, you agree and understand that you have:
- Voluntarily chosen to donate your breast milk to the Queensland Milk Bank
- Will not be paid for my donation and once donated my milk will not be returned to me
- My milk will not be sold for profit
- I give permission for my blood to be tested and understand that my GP healthcare provider will be notified if the results are positive
Queensland Health (QH) is required to manage your personal information in accordance with the Information Privacy Act 2009 and the Hospital and Health Boards Act 2011, Part 7 Confidentiality. QH is collecting the personal information on this form to assist in chart preparation for your pregnancy booking in visit and to assess your individual pregnancy health care needs. This form will be printed and filed in your patient medical record. Some of your personal information on your medical record may be given to carers, guardians or other government departments who provide associated services that require your information for the purpose of providing a health care service. Your information will be disclosed without your consent, if authorised or required by law. For further information about privacy and your health record please ask for a copy of the Queensland Health Privacy Brochure or visit www.health.qld.gov.au.