Forms 2003, 2004, 2005, 2006, 4003

Gene Therapy Product (Form 2003)
Infectious Disease Markers (Form 2004)
Confirmation of HLA Typing (Form 2005)
Hematopoietic Stem Cell Transplant (HCT) Infusion (Form 2006)
Cellular Therapy Product (Form 4003)

The following tables display how the 2004, 2005, and 2006 forms come due by donor types for HCT recipients.

The Forms 2003, 2004, 2005, 2006 and 4003 are generated based on the following:

• Form track (TED, CRF)
• HCT type (AUTO, ALLO_U, ALLO_R) *Reported on the F2814
• Donor type (NMDP, Non-NMDP, HLA type) *Reported on the F2400
• Product type (PBSC, BM, CBU) *Reported on the F2400
• Consent to Research Repository (Yes, No, NA, Not approached) *Reported on the F2400
• Was the donor previously used (Yes, No) *Reported on the F2400

*-If a Form 2005 has been completed for the recipient for a prior event date, another will not be made due.
-If the donor was used for a previous HCT or cellular therapy for the same recipient and 2005s were not captured for the donor and/or recipient, form(s) will be made due.
-In the case of cellular therapies occurring post-HCT, where the same donor is used from the prior HCT, no Form 2005s are required.
-A Form 2004 is required for each product type from a single donor.
-If you have any questions or think a form has been made due in error, please create a ticket in CIBMTR Center Support

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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.