Section 2: Completed by transferring FROM center

Section 2 of the recipient transfer tool is completed by the center the recipient is transferring FROM.

!The TO center and FROM center should be in contact with one another prior to completing the Recipient Transfer to ensure that both centers are referring to the same recipient and discuss reporting responsibilities with the transfer. If you are not able to reach the other center with the contact information FormsNet3^SM has provided, please submit a ticket to CIBMTR Center Support.

Confirmed patient with transferring TO Center:

Indicate yes if the patient has been confirmed with the transferring TO center. Indicate no if the FROM center has not been able to confirm the patient with the transferring TO center. If no is reported, a comment will be required to indicate why the patient has not been confirmed.

Agreed to effective date: (date the transferring TO center assumes responsibility for recipient)

Indicate yes if the effective date reported within the TO Center Data section is the date agreed upon by both centers. Indicate no if the effective date reported within the TO Center Data section is not the correct date agreed upon by both centers. If no is reported, enter the new effective date within the Proposed effective date field.

Data Manager agrees that reporting responsibility is transferring to TO center:

Check the checkbox to indicate that your center agrees that reporting responsibility will be moved to the transferring TO center.

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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.