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 Data Collection Forms

In order to minimize the burden of data collection and ensure that the most relevant data are collected, CIBMTR, in collaboration with the worldwide hematopoietic cell transplantation community, has developed a standard set of data elements to be collected for all transplant recipients.

Transplant centers can submit recipient data to CIBMTR using the forms below. Data can also be submitted electronically through FormsNet™ 2 and AGNIS®


Refine this list:
NumberAbrNameRevError CorrectionRelated Materials
2000 (PDF) 2000 Recipient Baseline Data 2.0 Error Correction (PDF) Instructions (PDF) Learn More...
2004 (PDF) IDM Infectious Disease Markers 2.0 Error Correction (PDF) Instructions (PDF) Learn More...
2005 (PDF) HLA Confirmation of HLA Typing 3.0 Error Correction (PDF) Instructions (PDF) Learn More...
2006 (PDF) INF Hematopoietic Stem Cell Transplant (HSCT) Infusion 2.0 Error Correction (PDF) Instructions (PDF) Learn More...
2010 (PDF) AML Acute Myelogenous Leukemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2011 (PDF) ALL Acute Lymphoblastic Leukemia Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2012 (PDF) CML Chronic Myelogenous Leukemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2013 (PDF) CLL Chronic Lymphocytic Leukemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2014 (PDF) MDS Myelodysplasia / Myeloproliferative Disorders Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2015 (PDF) JMML Juvenile Myelomonocytic Leukemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2016 (PDF) MYE Multiple Myeloma / Plasma Cell Leukemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2017 (PDF) AMY Amyloidosis Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2018 (PDF) LYM Hodgkin and Non-Hodgkin Lymphoma Pre-HSCT Data 1.1 Error Correction (PDF) Learn More...
2019 (PDF) MAC Waldenstrom's Macroglobulinemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2020 (PDF) BC Breast Cancer Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2021 (PDF) SCL Small Cell Lung Cancer Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2022 (PDF) TC Testicular / Germ Cell Cancer Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2023 (PDF) OV Ovarian Cancer Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2024 (PDF) SAR Sarcoma Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2025 (PDF) CNS Central Nervous System Tumor Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2026 (PDF) NEU Neuroblastoma Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2027 (PDF) RCC Renal Cell Carcinoma Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2028 (PDF) APL Aplastic Anemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2029 (PDF) FAN Fanconi Anemia / Constitutional Anemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2030 (PDF) SCA Sickle Cell Anemia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2031 (PDF) ID Immune Deficiencies Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2032 (PDF) CHS Chediak-Higashi Syndrome Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2033 (PDF) WAS Wiscott-Aldrich Syndrome Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2034 (PDF) XLP X-Linked Lymphoproliferative Syndrome Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2035 (PDF) CAT Congenital Amegakaryocytic Thrombocytopenia Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2036 (PDF) OST Osteopetrosis Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2037 (PDF) LDS Leukodystrophies Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2038 (PDF) MUC Mucopolysaccharidosis and other Storage Diseases Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2039 (PDF) FELH Hemophagocytic Lymphohistiocytosis Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2040 (PDF) LCH Langerhans Cell Histocytosis Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2041 (PDF) RA Rheumatoid Arthritis Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2042 (PDF) JRA Juvenile Idiopathic Arthritis Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2043 (PDF) MS Multiple Sclerosis Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2044 (PDF) SSC Systemic Sclerosis Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2045 (PDF) SLE Systemic Lupus Erythematosus Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2046 (PDF) FNG Fungal Infection Supplemental Data 2.0 Error Correction (PDF) Learn More...
2047 (PDF) HEP Hepatitis Serology 2.0 Error Correction (PDF) Learn More...
2048 (PDF) HIV Human Immunodeficiency Virus 2.0 Error Correction (PDF) Learn More...
2055 (PDF) CGD Chronic Granulomatous Disease (CGD) Pre-HSCT Data 1.0 Error Correction (PDF) Learn More...
2100 (PDF) 2100 100 Day Post-HSCT Data 2.0 Error Correction (PDF) Instructions (PDF) Learn More...
2110 (PDF) AML Acute Myelogenous Leukemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2111 (PDF) ALL Acute Lymphocytic Leukemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2112 (PDF) CML Chronic Myelogenous Leukemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2113 (PDF) CLL Chronic Lymphocytic Leukemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2114 (PDF) MDS Myelodysplasia / Myeloproliferative Disorders Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2115 (PDF) JMML / JCML Juvenile Myelomonocytic Leukemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2116 (PDF) MYE Multiple Myeloma / Plasma Cell Leukemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2117 (PDF) AMY Amyloidosis Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2118 (PDF) LYM Hodgkin and Non-Hodgkin Lymphoma Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2119 (PDF) MAC Waldenstrom's Macroglobulinemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2120 (PDF) BC Breast Cancer Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2121 (PDF) SCL Small Cell Lung Cancer Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2122 (PDF) TC Testicular / Germ Cell Cancer Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2123 (PDF) OV Ovarian Cancer Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2124 (PDF) SAR Sarcoma Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2125 (PDF) CNS Central Nervous System Tumor Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2126 (PDF) NEU Neuroblastoma Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2127 (PDF) RCC Renal Cell Carcinoma Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2128 (PDF) APL Aplastic Anemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2129 (PDF) FAN Fanconi Anemia / Constitutional Anemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2130 (PDF) SCA Sickle Cell Anemia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2131 (PDF) ID Immune Deficiencies Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2132 (PDF) CHS Chediak-Higashi Syndrome Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2133 (PDF) WAS Wiscott-Aldrich Syndrome Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2134 (PDF) XLP X-Linked Lymphoproliferative Syndrome Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2135 (PDF) CAT Congenital Amegakaryocytic Thrombocytopenia Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2136 (PDF) OST Osteopetrosis Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2137 (PDF) LDS Leukodystrophies Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2138 (PDF) MUC Mucopolysaccharidosis and other Storage Diseases Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2139 (PDF) FELH Hemophagocytic Lymphohistiocytosis Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2140 (PDF) LCH Langerhans Cell Histocytosis Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2141 (PDF) RA Rheumatoid Arthritis Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2142 (PDF) JRA Juvenile Idiopathic Arthritis Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2143 (PDF) MS Multiple Sclerosis Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2144 (PDF) SSC Systemic Sclerosis Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2145 (PDF) SLE Systemic Lupus Erythematosus Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2146 (PDF) FNG Fungal Infection Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2147 (PDF) HEP Hepatitis Serology Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2148 (PDF) HIV Human Immunodeficiency Virus Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2155 (PDF) CGD Chronic Granulomatous Disease Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2200 (PDF) 2200 Six Months to Two Years Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2300 (PDF) 2300 Yearly Follow-Up for Greater than Two Years Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2301 (PDF) Amnesty Plan Post-HSCT Data 1.0 Error Correction (PDF) Learn More...
2400 (PDF) Cover Sheet (PDF) Pre-TED Pre-Transplant Essential Data 2.0 Error Correction (PDF) Instructions (PDF) Learn More...
2450 (PDF) Cover Sheet (PDF) Post-TED Post-Transplant Essential Data 2.0 Error Correction (PDF) Instructions (PDF) Learn More...
2451 (PDF) Chimerism Chimerism Studies 1.0 Error Correction (PDF) Learn More...
2455 (PDF) Post-TED Selective Post-Transplant Essential Data 2.0 Error Correction (PDF) Learn More...
2503 (PDF) KGF KGF Study Supplement 1.0 Error Correction (PDF) Learn More...
2504 (PDF) KGF KGF Study Long-Term Follow-Up 1.0 Error Correction (PDF) Learn More...
2509 (PDF) Intravenous Busulfan Study — Supplemental Data 1.0 Error Correction (PDF) Learn More...
2800 (PDF) Log Log of Appended Documents 2.0 Error Correction (PDF) Learn More...
2801 (PDF) Recip Transfer Request for Recipient Transfer 2.0 Error Correction (PDF) Learn More...
2802 (PDF) Recip ltFU Lost to Follow-Up Declaration 2.0 Error Correction (PDF) Learn More...
2804 (PDF) CRID CIBMTR Recipient ID Assignment Form 3.0 Error Correction (PDF) Learn More...
2900 (PDF) 2900 Recipient Death Data 1.0 Error Correction (PDF) Learn More...
4000 (PDF) CTRM Cellular Therapies for Regenerative Medicine 1.0 Error Correction (PDF) Learn More...

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Last Updated: 11/22/2010 9:36 AM