Q105 – 118: Neurological Impairment / Disorder

The purpose of this section is to capture any impairments or disorders present during the current reporting period, regardless of treatment or intervention, unless otherwise specified. Review each impairment or disorder description to determine whether treatment or intervention is required for reporting the condition.

Question 105: Did the recipient experience a CNS hemorrhage?

A CNS hemorrhage is bleeding within the central nervous system.

Indicate if the recipient experienced a CNS hemorrhage in the current reporting period. The intent of this question is to capture each instance of a CNS hemorrhage occurring in the reporting period.

If the recipient did not have a CNS hemorrhage in the current reporting period or is unknown, select No.

*Reporting Multiple CNS Hemorrhages
Complete Date of CNS hemorrhage onset question to report multiple CNS hemorrhages by adding an additional instance in the FormsNet3^SM application.

Question 106: Date of CNS hemorrhage onset

Specify the date of the CNS hemorrhage. If multiple CNS hemorrhages occurred in one day, only one instance is required to capture the CNS hemorrhages occurring that day; multiple instances for the same day are not required.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

*Reporting Multiple Non-Infectious Encephalopathies
Complete Was non-infectious encephalopathy present through Date non-infectious encephalopathy resolved questions to report multiple non-infectious encephalopathies by adding an additional instance in the FormsNet3^SM application.

Questions 107 – 108: Was non-infectious encephalopathy present?

Non-infectious encephalopathy is the damage or disease of the brain. Symptoms include memory loss, personality changes, and declining ability to concentrate and reason.

Indicate if non-infectious encephalopathy was present in the current reporting period.

Report Developed in the following scenarios:

• This is the first time the recipient was diagnosed with non-infectious encephalopathy in the reporting period.
• Non-infectious encephalopathy disease resolved in a prior reporting period and then recurred in the current reporting period.

If non-infectious encephalopathy Developed, report the onset date. If the diagnosis was determined at an outside center and no documentation of a clinical, pathological, or laboratory assessment is available, the dictated date of diagnosis within a physician note may be reported.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Report Persisted in the following scenarios:

• Non-infectious encephalopathy was diagnosed pre-infusion and persisted into the Day 100 reporting period.
• Non-infectious encephalopathy was diagnosed (or persisted) in the prior reporting period and persisted into the current reporting period.

If non-infectious encephalopathy was not present in the current reporting period or unknown if present, select Not present.

Questions 109 – 110: Did non-infectious encephalopathy resolve?

Indicate if non-infectious encephalopathy resolved during the reporting period. If Yes, report the resolution date. The resolution date is the date when the notes specify the condition as resolved and / or medications to treat the condition were completed.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

*Reporting Multiple Neuropathies
Complete Was neuropathy present through Date neuropathy resolved questions to report multiple neuropathies by adding an additional instance in the FormsNet3^SM application.

Questions 111 – 112: Was neuropathy present?

Neuropathy is also known as nerve damage, typically in hands and feet, which causes pain, weakness, and numbness.

Indicate if neuropathy was present in the current reporting period.

Report Developed in the following scenarios:

• This is the first time the recipient was diagnosed with neuropathy in the reporting period.
• Neuropathy disease resolved in a prior reporting period and then recurred in the current reporting period.

If neuropathy Developed, report the onset date. If the diagnosis was determined at an outside center and no documentation of a clinical, pathological, or laboratory assessment is available, the dictated date of diagnosis within a physician note may be reported.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Report Persisted in the following scenarios:

• Neuropathy was diagnosed pre-infusion and persisted into the Day 100 reporting period.
• Neuropathy was diagnosed (or persisted) in the prior reporting period and persisted into the current reporting period.

If neuropathy was not present in the current reporting period or unknown if present, select Not present.

Questions 113 – 114: Did neuropathy resolve?

Indicate if neuropathy resolved during the reporting period. If Yes, report the resolution date. The resolution date is the date when the notes specify the condition as resolved and / or medications to treat the condition were completed.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 115: Did the recipient experience a seizure(s)?

Seizures are sudden, involuntary muscle contractions due to hyperexcitation of neurons.

Indicate if the recipient experienced a seizure(s) in the current reporting period. The intent of this question is to capture the first instance of a seizure occurring in the reporting period.

If the recipient did not have a seizure in the current reporting period or is unknown, select No.

Question 116: Date of a seizure(s) onset

Specify the date of the seizure. If multiple seizures occurred in the reporting period, only the first seizure needs to be reported. If multiple seizures occurred in one day, only one instance is required to capture the seizures occurring that day; multiple instances for the same day are not required.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 117: Did the recipient experience a stroke / transient ischemic attack?

A stroke / transient ischemic attack is the loss of brain function due to a disturbance in the blood supply to the brain.

Indicate if the recipient experienced a stroke / transient ischemic attack in the current reporting period. The intent of this question is to capture each instance of a stroke / transient ischemic attack occurring in the reporting period.

If the recipient did not have a stroke / transient ischemic attack in the current reporting period or is unknown, select No.

*Reporting Multiple Strokes / Transient Ischemic Attacks
Complete Date of stroke / transient ischemic attack onset question to report multiple strokes / transient ischemic attacks by adding an additional instance in the FormsNet3^SM application.

Question 118: Date of stroke / transient ischemic attack onset

Specify the date of the stroke / transient ischemic attack. If the recipient experienced different kinds of strokes in the reporting period, report a separate instance for each stroke type.

If multiple strokes / transient ischemic attacks occurred in one day, only one instance is required to capture the strokes / transient ischemic attacks occurring that day; multiple instances for the same day are not required.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
Q115	4/24/2026	Modify	Clarified intent of reporting seizures: Seizures are sudden, involuntary muscle contractions due to hyperexcitation of neurons. Indicate if the recipient experienced a seizure(s) in the current reporting period. The intent of this question is to capture each the first instance of a seizure occurring in the reporting period. If the recipient did not have a seizure in the current reporting period or is unknown, select No.	Due to change in instructions
Q116	4/24/2026	Modify	Removed the Reporting Multiple Seizures blue note box and updated instructions for reporting the seizure onset date: Reporting Multiple Seizures: Complete Date of a seizure(s) onset question to report multiple seizures by adding an additional instance in the FormsNet3SM application. Specify the date of the seizure. If multiple seizures occurred in the reporting period, only the first seizure needs to be reported. If multiple seizures occurred in one day, only one instance is required to capture the seizures occurring that day; multiple instances for the same day are not required.	Due to change in instructions

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