Informed Consent

*The timeline requirements for this form are as follows:
Assessment Time Frame: At the time of consent.
Submission Time Frame: As soon as possible after consent is obtained.

Date study ICF Signed:
Report the date the Informed Consent to Participate in Research Study for the study was signed by the subject or legally authorized representative. Date can either be entered directly in the data field using the DD/MMM/YYYY format, or the calendar date picker can be used.

If the date entered is a future date, a query will appear in the EDC.

Study ICF Version:
Report which version of the Informed Consent to Participate in Research Study was used to obtain subject or legally authorized representative consent. Indicate the version number and/or version date (up to 100 characters). This should be the ICF version, not the protocol version.

Study ICF Language:
Report language of the Informed Consent to Participate in Research Study used to obtain subject or legally authorized representative consent. If a short form was used, report the language, and indicate “short form.” For example, “Spanish short form.” (up to 100 characters).

CIBMTR Recipient Research IDs and Outcomes Database Consent

CIBMTR Research ID (CRID):
The CIBMTR Research ID (CRID) is a unique identifier assigned when an individual is registered with the CIBMTR as receiving a cellular therapy, including hematopoietic stem cell transplant (HCT), treatment for marrow toxic injuries, and certain non-cellular therapies. The CRID is generated using the CIBMTR Unique ID Assignment Form (Form 2804 in FormsNet3) and must be completed for all HCT recipients.

Report the subject’s CRID. This should be entered as 8 numeric characters (without dashes or symbols). If the CRID contains <8 numbers, enter leading zeros so 8 total characters are entered (e.g., CRID “1234567” should be entered as “01234567).

NMDP Recipient ID (RID) (if applicable):
Enter the subject’s National Marrow Donor Program (NMDP) Recipient ID (RID). This should be entered as 7 numeric characters, without dashes or symbols (i.e., RID is 712-543-6 should be entered as 7125436). If subject does not proceed to transplant and RID is not generated, mark field as Intentionally Left Blank.

Did recipient consent to CIBMTR Research Outcomes database:
Indicate whether the study participant or legally authorized representative has consented to providing data to the CIBMTR Research Outcomes database.

CCG v1.0 | CRF v1.3

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CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.