A transplant center designated as a Comprehensive Report Form center will submit data on the Pre-TED Form, followed by either the Post-TED Form or the Comprehensive Report Forms. The type of follow-up form used for a specific recipient is determined by the CIBMTR’s form selection algorithm (see General Instructions, Center Type and Data Collection Forms).
The Baseline Form is one of the Comprehensive Report Forms. This form captures pre-HCT data such as: recipient demographics, organ function and hematologic status, preparative regimen, and socioeconomic information. The Baseline Form is due within 60 days after HCT.
For recipients receiving a subsequent HCT, the recipient will remain on the original follow-up form track (TED or Comprehensive Report Forms) assigned by the form selection algorithm, except for situations where the recipient has enrolled into a study requiring comprehensive report forms. For recipients assigned to Comprehensive Report Forms by the form selection algorithm, centers will submit an additional Pre-TED form.
Q1-3: Clinical Status of Recipient Prior to the Preparative Regimen
Q4-22: Organ Function Prior to the Preparative Regimen
Q23-34: Hematologic Findings Prior to the Preparative Regimen
Q35-38: Infection
Q39-85: Pre-HCT Preparative Regimen
Q86-103: Additional Drugs Given in the Peri-Transplant Period
Q104-117: Socioeconomic Information
Manual Updates:
Sections of the Forms Instruction Manual are frequently updated. The most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.
If you need to reference the historical Manual Change History for this form, please click here or reference the retired manual section on the Retired Forms Manuals webpage.
| Date | Manual Section | Add/Remove/Modify | Description |
|---|---|---|---|
| 5/6/2021 | 2000: Recipient Baseline | Add | Question 2 updated with instructions on how to report use of naswar or paan: Indicate the recipient’s smoking and / or chewing tobacco use from the options listed. Select “chewing tobacco” if the recipient has a history using naswar and / or paan. If “cigarettes” is selected, continue with question 3. |
| 10/23/2020 | 2000: Recipient Baseline | Modify | Version 4 of the 2000: Recipient Baseline section of the Forms Instruction Manual released. Version 4 corresponds to revision 6 of the Form 2000. |
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