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:
| Number | Abbr | Name | Rev | Error Correction | Related Materials |
|---|---|---|---|---|---|
| 2000 (PDF) | 2000 | Recipient Baseline Data | 2.0 | Error Correction (PDF) |
Instructions (PDF) Learn More... |
| 2000 [RETIRED] | 2000 | Recipient Baseline Data | 1.0 | Error Correction (PDF) | Learn More... |
| 2004 (PDF) | IDM | Infectious Disease Markers | 2.0 | Error Correction (PDF) | Learn More... |
| 2004 [RETIRED] | IDM | Infectious Disease Markers | 1.0 | Error Correction (PDF) | Learn More... |
| 2005 (PDF) | HLA | Confirmation of HLA Typing | 3.0 | Error Correction (PDF) |
Instructions (PDF) Learn More... |
| 2005 [RETIRED] | HLA | Confirmation of HLA Typing | 2.0 | Error Correction (PDF) | Learn More... |
| 2005 [RETIRED] | HLA | Confirmation of HLA Typing | 1.0 | Error Correction (PDF) | Learn More... |
| 2006 (PDF) | INF | Hematopoietic Stem Cell Transplant (HSCT) Infusion | 2.0 | Error Correction (PDF) | Learn More... |
| 2006 [RETIRED] | INF | Hematopoietic Stem Cell Transplant (HSCT) Infusion | 1.0 | Error Correction (PDF) | Learn More... |
| 2010 (PDF) | AML | Acute Myelogenous Leukemia Pre-HSCT Data | 1.0 | Error Correction (PDF) | Learn More... |
| 2011 (PDF) | ALL | Acute Lymphocytic Leukemia Pre-HSCT Data | 1.0 | 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... |
| 2031 [RETIRED] | ID | Immune Deficiencies Pre-HSCT Data | 1.0 | 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... |
| 2033 [RETIRED] | WAS | Wiscott-Aldrich Syndrome Pre-HSCT Data | 1.0 | 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 | 1.0 | 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 | 1.0 | Error Correction (PDF) | Learn More... |
| 2046 (PDF) | FNG | Fungal Infection Supplemental Data | 2.0 | Error Correction (PDF) | Learn More... |
| 2046 [RETIRED] | FNG | Fungal Infection Supplemental Data | 1.0 | Error Correction (PDF) | Learn More... |
| 2047 (PDF) | HEP | Hepatitis Serology | 2.0 | Error Correction (PDF) | Learn More... |
| 2047 [RETIRED] | HEP | Hepatitis Serology | 1.0 | Error Correction (PDF) | Learn More... |
| 2048 (PDF) | HIV | Human Immunodeficiency Virus | 2.0 | Error Correction (PDF) | Learn More... |
| 2048 [RETIRED] | HIV | Human Immunodeficiency Virus | 1.0 | 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) | Learn More... |
| 2100 [RETIRED] | 2100 | 100 Day Post-HSCT Data | 1.0 | Error Correction (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... |
| 2131 [RETIRED] | ID | Immune Deficiencies Post-HSCT Data | 1.0 | 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... |
| 2133 [RETIRED] | WAS | Wiscott-Aldrich Syndrome Post-HSCT Data | 1.0 | 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 | 1.0 | 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 | 1.0 | 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... |
| 2147 [RETIRED] | HEP | Hepatitis Serology Post-HSCT Data | 1.0 | Error Correction (PDF) | Learn More... |
| 2148 (PDF) | HIV | Human Immunodeficiency Virus Post-HSCT Data | 2.0 | Error Correction (PDF) | Learn More... |
| 2148 [RETIRED] | HIV | Human Immunodeficiency Virus Post-HSCT Data | 1.0 | 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... |
| 2200 [RETIRED] | 2200 | Six Months to Two Years Post-HSCT Data | 1.0 | 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... |
| 2300 [RETIRED] | 2300 | Yearly Follow-Up for Greater than Two Years Post-HSCT Data | 1.0 | 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) | Learn More... |
| 2400 [RETIRED] | Pre-TED | Pre-Transplant Essential Data | 1.0 | Error Correction (PDF) | Learn More... |
|
2450 (PDF)
Cover Sheet (PDF) |
Post-TED | Post-Transplant Essential Data | 2.0 | Error Correction (PDF) | Learn More... |
| 2450 [RETIRED] | Post-TED | Post-Transplant Essential Data | 1.0 | Error Correction (PDF) | Learn More... |
| 2451 (PDF) | Post TED | Chimerism | 1.0 | Error Correction (PDF) | Learn More... |
| 2455 (PDF) | Post-TED | Selective Post-Transplant Essential Data | 2.0 | Error Correction (PDF) | Learn More... |
| 2455 [RETIRED] | Post-TED | Selective Post-Transplant Essential Data | 1.0 | Error Correction (PDF) | Learn More... |
| 2503 (PDF) | KGF | KGF Study Supplement | 1.0 | Learn More... | |
| 2504 (PDF) | KGF | KGF Study Long-Term Follow-Up | 1.0 | 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... |
| 2800 [RETIRED] | Log | Log of Appended Documents | 1.0 | Error Correction (PDF) | Learn More... |
| 2801 (PDF) | Recip Transfer | Request for Recipient Transfer | 2.0 | Error Correction (PDF) | Learn More... |
| 2801 [RETIRED] | Recip Transfer | Request for Recipient Transfer | 1.0 | Error Correction (PDF) | Learn More... |
| 2802 (PDF) | Recip ltFU | Lost to Follow-Up Declaration | 2.0 | Error Correction (PDF) | Learn More... |
| 2802 [RETIRED] | Recip ltFU | Lost to Follow-Up Declaration | 1.0 | Error Correction (PDF) | Learn More... |
| 2804 (PDF) | CRID | Unique ID Assignment / CRID | 2.0 | Error Correction (PDF) | Learn More... |
| 2804 [RETIRED] | CRID | Unique ID Assignment | 1.0 | Error Correction (PDF) | Learn More... |
| 2900 (PDF) | 2900 | Recipient Death Data | 1.0 | Error Correction (PDF) | Learn More... |
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