Q1 – 4: Recipient Death

!No Documentation of Contact Date
The contact date data field cannot be left blank and is required to be reported. In cases where the recipient passed away and there is no documentation to report the date of death, the guidelines for reporting estimated dates must be used.

Question 1: Date of death

Report the date the recipient died. Confirm that the date matches the last date of actual contact reported on the Post-TED (2450), Post-Infusion Follow-Up (2100), or Cellular Therapy Essential Data Follow-Up (4100) form.

If the death occurred at an outside location and records of death are not available, the dictated date of death within a physician note may be reported. If the progress notes detailing the circumstances of death are available, request these records. These records are useful for completing required follow-up data fields on the post-infusion forms and the cause of death data fields on this form.

If the exact date of death is not known, select Date estimated and use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.

Question 2: Was cause of death confirmed by autopsy?

Indicate if the cause of death was confirmed by autopsy.

If Autopsy pending is selected, the form will not go to complete (CMP) status until the autopsy results are reported. The form may be submitted with this question answered as Autopsy pending, but the form will remain in saved (SVD) status until it is updated with the results. Once the autopsy results are known, update this question and the Primary cause of death, if applicable, to ensure all pertinent causes of death are reported, then resubmit to complete the form.

*Autopsy Report
It is strongly encouraged to attach the autopsy report if documentation is available.
For further instructions on how to attach documents in FormsNet3^SM, refer to the training guide.

*Primary and Contributing Cause(s) of Death
Report the primary and contributing cause(s) of death based on the physician’s determination. If the cause of death is unclear, seek physician clarification to determine the appropriate cause of death.

!Cause of Death Options
Review the Cause of Death Options section for additional information to ensure accurate cause of death reporting.

Questions 3 – 4: Primary cause of death

Report the underlying cause of death. The Centers for Disease Control and Prevention, National Center for Health Statistics notes the underlying cause of death is “the disease or injury that initiated the chain of events that led directly or inevitably to death.”

Report only one primary cause of death. If additional information is required, the details will be reported in Specify data field below. Information reported in the Specify field must pertain to the option selected (i.e., an infectious cause of death should be specified for Other infection).

If the recipient has recurrent / persistent / progressive disease at the time of death, consider if the disease was the primary cause of death or a contributing cause of death. It should not be assumed that the presence of the recipient’s primary disease indicates that the disease was the primary cause of death.

If a cause of death has related questions on the comprehensive report form, report the appropriate data in both locations. For example, if a primary cause of death was infection, complete the infection data fields on the comprehensive report form. Review the Cause of Death Options section for additional details.

If the primary cause of death is unclear, consult with a physician for their best medical opinion.

Section Updates

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (if applicable)
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