Date blood drawn __________
Enter the date the blood specimen was collected and used to obtain the Donor Specific Antibody result. Enter the date in the DD/MMM/YYYY.
Is test draw date within 3 months prior to enrollment?
- Yes
- No
Was DSA detected above acceptable background level
Indicate if DSA was detected above the acceptable background level.
- Yes
- No
Upload a de-indentified copy of the DSA detection results __________
Upload a de-identified copy of the DSA results that includes the participants Kidney Tolerance study ID number. If multiple DSA results were reported, upload the assessment closest to the transplant date. Acceptable file types include: PDF, DOC, and DOCX.
Retain a copy of the DSA results in the case history file
CCG v.1 | CRF v.1
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