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Check your risk of Hepatitis A
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Yes
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No
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1.
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Do you believe you have been exposed to hepatitis A in the past 2 weeks?
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2.
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Do you live with someone currently ill with hepatitis A?
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3.
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Have you had sex with someone currently ill with hepatitis A?
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4.
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Do you currently live in a region of the United States where hepatitis A rates are very high?
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5.
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Do you travel or work in an area outside of the U.S. where hepatitis A is a problem? (This includes everywhere EXCEPT Australia, New Zealand, Western Europe, Japan, and Canada)
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6.
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If you are a man, do you have sex with other men?
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7.
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Are you an injecting or non-injecting (snort cocaine) drug user?
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Check your risk of Hepatitis B
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Yes
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No
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1.
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Is someone in your household infected with Hepatitis B?
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2.
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Have you ever been diagnosed with a sexually transmitted disease?
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3.
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Have you had sex with more than one partner in a 6-month period?
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4.
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If you are a man, do you have sex with other men?
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5.
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Have you or any of your sex partner(s) ever injected illegal drugs?
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6.
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Have you ever shared equipment (needles, syringes, cotton, water, etc) when injecting drugs with someone else?
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7.
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Have you ever received hemodialysis?
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8.
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Did your mother have Hepatitis B when you were born?
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9.
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Have you worked in a health care or other occupation where you had a needle stick injury or other sharps exposures on the job?
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10.
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Have you shared a toothbrush, razor, or any other item that might have blood on it (visible or not) with a person who has hepatitis B?
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Check your risk of Hepatitis C
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Yes
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No
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1.
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Did you receive a blood transfusion or solid organ transplant (heart, lung, liver, pancreas, kidney) before July 1992?
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2.
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Did you receive clotting factor concentrates produced before 1987?
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3.
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Have you ever received hemodialysis?
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4.
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Have you had blood tests that showed a liver problem?
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5.
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Have you had a needle stick injury working in a health care setting?
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6.
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Did your mother have Hepatitis C when you were born?
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7.
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Have you shared a toothbrush, razor, or any other item that might have blood on it (visible or not) with a person who has hepatitis C?
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8.
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Have you or any of your sex partner(s) injected illegal drugs, even if it was only one time many years ago?
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Check if you are at risk
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Yes
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No
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1.
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You could be at risk if you have, in the last 12 months, had vaginal or anal sex…
Without using a condom?
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2.
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With a person of unknown HIV status?
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