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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.

Submitting Paper Forms

Use the links in the table below to print paper forms for submission to CIBMTR. These forms are the most current versions of the forms and the only version that may be submitted.  We accept paper forms to be keyed by CIBMTR staff but encourage centers when at all possible to submit forms electronically through either FormsNet3SM or AGNIS. These electronic submission mechanisms allow for immediate validation of data allowing centers to correct or validate data prior to submission.
  

Data Management Manual

Instructions for completing the forms can be found under the Data Management Manual link.


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NumberAbrNameRevError CorrectionRelated Materials
2000 (PDF) 2000 Recipient Baseline Data 4.0 Error Correction (PDF) Learn More...
2000 (PDF-RF) 2000 Recipient Baseline Data 4.0 Error Correction (PDF) Learn More...
2004 (PDF) IDM Infectious Disease Markers 4.0 Error Correction (PDF) Learn More...
2004 (PDF-RF) IDM Infectious Disease Markers 4.0 Error Correction (PDF) Learn More...
2005 (PDF) HLA Confirmation of HLA Typing 5.0 Error Correction (PDF) Learn More...
2005 (PDF-RF) HLA Confirmation of HLA Typing 5.0 Error Correction (PDF) Learn More...
2006 (PDF) INF Hematopoietic Stem Cell Transplant (HCT) Infusion 4.0 Error Correction (PDF) Learn More...
2006 (PDF-RF) INF Hematopoietic Stem Cell Transplant (HCT) Infusion 4.0 Error Correction (PDF) Learn More...
2008 (PDF) 2008 HCT Canceled or Delayed 1.0 Error Correction (PDF) Learn More...
2010 (PDF) AML Acute Myelogenous Leukemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2010 (PDF-RF) AML Acute Myelogenous Leukemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2011 (PDF) ALL Acute Lymphoblastic Leukemia Pre-HCT Data 4.0 Error Correction (PDF) Learn More...
2011 (PDF-RF) ALL Acute Lymphoblastic Leukemia Pre-HCT Data 4.0 Error Correction (PDF) Learn More...
2012 (PDF) CML Chronic Myelogenous Leukemia Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2013 (PDF) CLL Chronic Lymphocytic Leukemia Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2014 (PDF) MDS Myelodysplasia / Myeloproliferative Disorders Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2014 (PDF-RF) MDS Myelodysplasia / Myeloproliferative Disorders Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2015 (PDF) JMML Juvenile Myelomonocytic Leukemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2015 (PDF-RF) JMML Juvenile Myelomonocytic Leukemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2016 (PDF) PCD Multiple Myeloma / Plasma Cell Leukemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2016 (PDF-RF) PCD Multiple Myeloma / Plasma Cell Leukemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2018 (PDF) LYM Hodgkin and Non-Hodgkin Lymphoma Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2018 (PDF-RF) LYM Hodgkin and Non-Hodgkin Lymphoma Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2019 (PDF) MAC Waldenstrom's Macroglobulinemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2019 (PDF-RF) MAC Waldenstrom's Macroglobulinemia Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2020 (PDF) BC Breast Cancer Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2021 (PDF) SCL Small Cell Lung Cancer Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2022 (PDF) TC Testicular / Germ Cell Cancer Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2023 (PDF) OV Ovarian Cancer Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2024 (PDF) SAR Sarcoma Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2025 (PDF) CNS Central Nervous System Tumor Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2026 (PDF) NEU Neuroblastoma Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2027 (PDF) RCC Renal Cell Carcinoma Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2028 (PDF) APL Aplastic Anemia Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2029 (PDF) FAN Fanconi Anemia / Constitutional Anemia Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2030 (PDF) SCA Sickle Cell Anemia Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2031 (PDF) ID Immune Deficiencies Pre-HSCT Data 3.0 Error Correction (PDF) Learn More...
2033 (PDF) WAS Wiscott-Aldrich Syndrome Pre-HSCT Data 3.0 Error Correction (PDF) Learn More...
2034 (PDF) XLP X-Linked Lymphoproliferative Syndrome Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2034 (PDF-RF) XLP X-Linked Lymphoproliferative Syndrome Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2035 (PDF) CAT Congenital Amegakaryocytic Thrombocytopenia Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2036 (PDF) OST Osteopetrosis Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2037 (PDF) LDS Leukodystrophies Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2038 (PDF) MUC Mucopolysaccharidosis and other Storage Diseases Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2039 (PDF) HLH Hemophagocytic Lymphohistiocytosis Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2039 (PDF-RF) HLH Hemophagocytic Lymphohistiocytosis Pre-HCT Data 3.0 Error Correction (PDF) Learn More...
2040 (PDF) LCH Langerhans Cell Histocytosis Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2041 (PDF) RA Rheumatoid Arthritis Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2042 (PDF) JRA Juvenile Idiopathic Arthritis Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2043 (PDF) MS Multiple Sclerosis Pre-HSCT Data 3.0 Error Correction (PDF) Learn More...
2044 (PDF) SSC Systemic Sclerosis Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2045 (PDF) SLE Systemic Lupus Erythematosus Pre-HSCT Data 3.0 Error Correction (PDF) Learn More...
2046 (PDF) FNG Fungal Infection Supplemental Data 3.0 Error Correction (PDF) Learn More...
2047 (PDF) HEP Hepatitis Serology 3.0 Error Correction (PDF) Learn More...
2048 (PDF) HIV Human Immunodeficiency Virus 3.0 Error Correction (PDF) Learn More...
2055 (PDF) CGD Chronic Granulomatous Disease (CGD) Pre-HSCT Data 2.0 Error Correction (PDF) Learn More...
2056 (PDF) PDD Pigmentary Dilution Disorder (PDD) Pre-HCT Data 1.0 Error Correction (PDF) Learn More...
2056 (PDF-RF) PDD Pigmentary Dilution Disorder (PDD) Pre-HCT Data 1.0 Error Correction (PDF) Learn More...
2100 (PDF) 2100 100 Day Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2110 (PDF) AML Acute Myelogenous Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2110 (PDF-RF) AML Acute Myelogenous Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2111 (PDF) ALL Acute Lymphocytic Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2111 (PDF-RF) ALL Acute Lymphocytic Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2112 (PDF) CML Chronic Myelogenous Leukemia Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2113 (PDF) CLL Chronic Lymphocytic Leukemia Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2114 (PDF) MDS Myelodysplasia / Myeloproliferative Disorders Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2114 (PDF-RF) MDS Myelodysplasia / Myeloproliferative Disorders Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2115 (PDF) JMML / JCML Juvenile Myelomonocytic Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2115 (PDF-RF) JMML / JCML Juvenile Myelomonocytic Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2116 (PDF) PCD Multiple Myeloma / Plasma Cell Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2116 (PDF-RF) PCD Multiple Myeloma / Plasma Cell Leukemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2118 (PDF) LYM Hodgkin and Non-Hodgkin Lymphoma Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2118 (PDF-RF) LYM Hodgkin and Non-Hodgkin Lymphoma Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2119 (PDF) MAC Waldenstrom's Macroglobulinemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2119 (PDF-RF) MAC Waldenstrom's Macroglobulinemia Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2120 (PDF) BC Breast Cancer Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2121 (PDF) SCL Small Cell Lung Cancer Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2122 (PDF) TC Testicular / Germ Cell Cancer Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2123 (PDF) OV Ovarian Cancer Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2124 (PDF) SAR Sarcoma Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2125 (PDF) CNS Central Nervous System Tumor Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2126 (PDF) NEU Neuroblastoma Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2127 (PDF) RCC Renal Cell Carcinoma Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2128 (PDF) APL Aplastic Anemia Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2129 (PDF) FAN Fanconi Anemia / Constitutional Anemia Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2130 (PDF) SCA Sickle Cell Anemia Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2131 (PDF) ID Immune Deficiencies Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2133 (PDF) WAS Wiscott-Aldrich Syndrome Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2134 (PDF) XLP X-Linked Lymphoproliferative Syndrome Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2134 (PDF-RF) XLP X-Linked Lymphoproliferative Syndrome Post-HCT Data 3.0 Error Correction (PDF) Learn More...
2135 (PDF) CAT Congenital Amegakaryocytic Thrombocytopenia Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2136 (PDF) OST Osteopetrosis Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2137 (PDF) LDS Leukodystrophies Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2138 (PDF) MUC Mucopolysaccharidosis and other Storage Diseases Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2139 (PDF) HLH Hemophagocytic Lymphohistiocytosis Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2139 (PDF-RF) HLH Hemophagocytic Lymphohistiocytosis Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2140 (PDF) LCH Langerhans Cell Histocytosis Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2141 (PDF) RA Rheumatoid Arthritis Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2142 (PDF) JRA Juvenile Idiopathic Arthritis Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2143 (PDF) MS Multiple Sclerosis Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2144(PDF) SSC Systemic Sclerosis Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2145 (PDF) SLE Systemic Lupus Erythematosus Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2146 (PDF) FNG Fungal Infection Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2147 (PDF) HEP Hepatitis Serology Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2148 (PDF) HIV Human Immunodeficiency Virus Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2155 (PDF) CGD Chronic Granulomatous Disease Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2156 (PDF) PDD Pigmentary Diluton Disorder (PDD) Post-HCT Data 1.0 Error Correction (PDF) Learn More...
2156 (PDF-RF) PDD Pigmentary Diluton Disorder (PDD) Post-HCT Data 1.0 Error Correction (PDF) Learn More...
2200 (PDF) 2200 Six Months to Two Years Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2300 (PDF) 2300 Yearly Follow-Up for Greater than Two Years Post-HSCT Data 3.0 Error Correction (PDF) Learn More...
2301 (PDF) 2301 Amnesty Plan Post-HSCT Data 2.0 Error Correction (PDF) Learn More...
2400 (PDF) Pre-TED Pre-Transplant Essential Data 4.0 Error Correction (PDF) Learn More...
2400 (PDF-RF) Pre-TED Pre-Transplant Essential Data 4.0 Error Correction (PDF) Learn More...
2400 (PDF-RF) Cover Page Pre-TED Cover Page 2400 Cover Page (Used with PDF-RF only to indicate which sections are included when form is submitted on paper.) 4.0 Error Correction (PDF) Learn More...
2450 (PDF) Post-TED Post-Transplant Essential Data 3.0 Error Correction (PDF) Learn More...
2451 (PDF) Chimerism Chimerism Studies 2.0 Error Correction (PDF) Learn More...
2455 (PDF) Post-TED Selective Post-Transplant Essential Data 3.0 Error Correction (PDF) Learn More...
2503 (PDF) KGF KGF Study Supplement 2.0 Error Correction (PDF) Learn More...
2504 (PDF) KGF KGF Study Long-Term Follow-Up 2.0 Error Correction (PDF) Learn More...
2509 (PDF) Intravenous Busulfan Study — Supplemental Data 2.0 Error Correction (PDF) Learn More...
2520 (PDF) AML-ALL Study R02-09 AML/ALL - Supplemental Form 1.0 Error Correction (PDF) Learn More...
2521 (PDF) MDS Study R02-09 MDS - Supplemental Form 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 3.0 Error Correction (PDF) Learn More...
2804 (PDF) CRID CIBMTR Recipient ID Assignment Form 4.0 Error Correction (PDF) Learn More...
2900 (PDF) 2900 Recipient Death Data 2.0 Error Correction (PDF) Learn More...
4000 (PDF) CTRM Cellular Therapies for Regenerative Medicine 2.0 Error Correction (PDF) Learn More...

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Last Updated: 5/7/2014 1:55 PM