Indicate and provide identifiers for all other outcomes registries the individual’s data are being reported to. If the individual’s data are not being reported to any other outcomes registries, continue with the signature section of the form. If the individual’s data are being reported to multiple additional outcomes registries, create a new instance for each additional outcomes registry.
Question 19: Specify outcomes registry
IIndicate all outcomes registries the individual’s data are being reported to; if the individual is participating in more than one registry, add a new instance for each. As a reference, the registry acronyms and instructions for proceeding with the remainder of the form are detailed below:
- EBMT: European Society for Blood and Marrow Transplantation, continue with question 20.
- USIDNET: United States Immunodeficiency Network, continue with question 22.
- APBMT: Asia-Pacific Blood and Marrow Transplantation Group, continue with question 22.
- CBMTG: Canadian Blood and Marrow Transplant Group, continue with the signature section of the form or create an additional instance of questions 19-22 to report additional outcomes registries.
- EMBMT: Eastern Mediterranean Blood and Marrow Transplantation Group, continue with question 22.
- The National MDS Study: The National MDS Study refers to an NHLBI-sponsored study looking at the natural history of MDS; this is not the same as 10-CMSMDS-1, the HCT for MDS Medicare Study. If the individual’s data are being reported to the National MDS Study, continue with question 22.
- Other outcomes registry, continue with question 21
Question 20: EBMT CIC
For individual with data reported to EBMT, report the four- to five-digit Centre Identification Code (CIC) identifying the transplant center. Continue with question 22 and specify the EBMT subject identifier.
Question 21: Specify other outcomes registry
Report the other outcomes registry individual data are being reported to. Use the complete registry name, rather than acronyms or abbreviations. Continue with question 22.
Question 22: Outcomes registry subject ID
Report the registry subject ID for the applicable registry; if multiple instances of questions 19-22 are being reported, ensure the registry subject ID corresponds with the registry indicated in the same instance of question 19.
|Question Number||Date of Change||Add/Remove/Modify||Description||Reasoning (If applicable)|