Section 1 of the recipient transfer tool is completed by the center where the recipient is transferring TO.
Confirmed patient with transferring center:
Check the checkbox to indicate that the transferring center has confirmed the patient with the transferring center.
Agreed upon effective date: (date the transferring center assumes responsibility for recipient)
This is the date the two centers agreed that the center will take responsibility for the reporting on the recipient. If there has been a subsequent infusion at the center, the agree upon effective date must be prior to the subsequent infusion date. Any of the dates below would be acceptable:
- The day the recipient was first seen at the center
- The date the recipient signed consent at the center
- The day before preparative regimen began
- The day before the infusion
It is most important that the date is prior to any subsequent infusion at the center to ensure the new forms come due at the correct center. Forms with an earliest complete date that are on or after the effective date will be moved to the transferring center. Forms with an earliest complete date before the effective date will remain at the transferring center.
Was a duplicate CRID created at your center:
When discussing the transfer, the centers will have discovered whether the center has created a CRID for the recipient before realizing that a CRID already existed. This CRID will be merged with the original CRID by the CIBMTR CRC as part of the transfer process.
Indicate Yes or No if the transferring center created a duplicate CRID.
Enter the duplicate CRID number if Yes was reported in the previous question.
Reason for transfer:
Select the reason that the recipient is transferring to the new center.
- Center Closed – the recipient’s original center is closing or has closed.
- Center split / merged – the center has either divided into two branches or has changed from a two-branch program to one single CIBMTR center.
- Follow-up care – the recipient will be receiving follow-up care at the center and a subsequent infusion is not planned at the time the transfer is being completed. Examples may include transferring due to patient moving out of state or changes related to insurance.
- Subsequent infusion – the recipient is receiving / has received a subsequent infusion at the center.
Date of subsequent infusion:
Enter the date of the subsequent infusion at the center using the YYYY/MM/DD format.
Data Manager agrees that their center will assume reporting responsibility:
Check the checkbox to indicate that the transferring center has agreed to assume reporting responsibilities.