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.
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 |
|---|---|---|---|
| 4/4/2024 | 2000: Recipient Baseline | Add | Plasma vs Serum Samples blue box added above Q4 |
| 7/28/2023 | 2000: Recipient Baseline | Add | Red warning box added above Q115 to clarify question is now disabled: Specify the recipient’s combined household gross annual income is disabled. This question will be updated with the next revision of the Recipient Baseline (2000) Form. |
| 5/1/2023 | 2000: Recipient Baseline | Add | Instructions for Q87 and 95 updated to define peri-transplant period: Report the total dose actually given during the peri-transplant period (before and after infusion). Do not report the prescribed dose or the daily dose. The pharmacy record or Medication Administration Record (MAR) should be used for determining the exact total dose given. |
| 5/1/2023 | 2000: Recipient Baseline | Add | Instructions above Q86 updated to define peri-transplant period: Drugs may be given during the peri-transplant (before and after infusion) period to prevent transplant-related complications or facilitate engraftment. |
| 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. |
Need more help with this?
Don’t hesitate to contact us here.