Question 1: Did this Form 2820 become due because the recipient agreed to direct contact by CIBMTR for research studies as indicated on Form 2400?

This question should be answered ‘yes’ if the recipient has given permission to be directly contacted by CIBMTR for research as indicated on the Pre-TED F2400. This will allow CIBMTR to contact the patient and invite them to participate in PRO data collection or other research studies.

Question 2: Did this Form 2820 become due because the recipient agreed to participation in a specific study (e.g. BMT CTN)?

This question indicates if contact information is being provided for a patient who is enrolled in a specific clinical trial instead of, or in addition to, contact for future research.

Question 3: Indicate for which of the following studies the contact form will be used (check all that apply)

Indicate the specific study or studies the recipient is enrolled in. Currently this includes BMT CTN 1702 (Donor Source/CTRL-ALT-D), 1703/1801 (aGVHD prophylaxis/Mi-Immune) and 1704 (CHARM) studies, all of which include Patient Reported Outcome data collection by CIBMTR. If the recipient is co-enrolled in multiple studies, then copy and paste questions 3 and 4 to indicate more than one study.

Question 4: Study enrollment date:

Enter the date the recipient enrolled in the study or studies listed in question 3. If the recipient is co-enrolled in multiple BMT CTN studies then copy and paste questions 3 and 4 to report each date of enrollment.

Question 5: Is the recipient an adult (18 years of age or older) or emancipated minor?

Select ‘yes’ to question 5 if:

  1. The recipient is a legal adult.
  2. The recipient is an emancipated minor.

If the recipient is not a legal adult or emancipated minor then the parent / legal guardian section of this form (Q22- Q38) will be enabled and must be completed.

Select ‘no’ to question 5 if the recipient is over the age of 18 but does not show adequate capacity to consent for themselves. The parent / legal guardian section of this form (Q22 – Q38) will be enabled to capture contact information for the surrogate providing consent for the recipient.

Last modified: Apr 06, 2020

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