WMDA form: F10

Name F10
Description Formal Request for Stem Cell or Lymphocyte Collection

Dictionary Fields

Name of field on form Dictionary label (description) EMDIS fields (matching dictionary field) WMDA XML fields (matching dictionary field)
Preferred date (collection/shipment) 2
(Transplant centre collection/shipment date preference)
ALTER_DATE1
Preferred date (collection/shipment) 3
(Transplant centre collection/shipment date preference)
ALTER_DATE2
Total number of days of conditioning regimen
(The number of condititioning days the patient will have prior to transplantation)
COND_DAYS
Number of previous HPC donations
(Number of times a donor has previously donated either HPC(A) or HPC(M))
D_NMBR_MARR
D_NMBR_PBSC
NMBR_MARR
NMBR_PBSC
Preferred date (collection/shipment) 1
(First preferred date for collection / CBU shipment)
PROP_DATE
Product request
(Requesting TC/registry's product preference)
WOR_REQ_TYPE
Weight
(Weight measured in kilograms)
D_WEIGHT
P_WEIGHT
WEIGHT
Blood Group (ABO)
(Blood Group (ABO))
CB_ABO
D_ABO
D_ABO (IDM_RES)
P_ABO
ABO
Blood Group (Rhesus)
(Blood Group (Rhesus))
RHESUS
First line of address
(The first line of an address, generally for an organisation, can be any format)
ADDR_1
Second line of address
(The second line of an address, generally for an organisation, can be any format)
ADDR_2
Third line address
(The third line of an address, generally for an organisation, can be any format)
ADDR_3
City Address
(The city of an address, generally for an organisation, can be any format)
CITY
CMV antibodies test result
(The test result to reflect the evidence of CMV antibodies)
CB_ANTI_CMV
CB_MAT_ANTI_CMV
D_ANTI_CMV
P_CMV
ANTI_CMV
Country
(The country of an address, generally for an organisation, can be any format)
COUNTRY
Email
(email address, generally for an organisation, can be any format)
EMAIL
Fax Number
(Fax number, usually of an organisation)
FAX
Receiving institution
(Institution receiving a product ( sample, HPC))
INST_MARR_SENT
INST_SMP_SENT
Invoice institution
(institution responsible for paying, usually requesting TC or registry)
INST_PAY
Request date
(Date of request)
REQ_DATE
Postal Code
(Post code of an organisation such as a registry or TC)
ZIP
Date of birth
(Birth date)
CB_BIRTH_DATE
D_BIRTH_DATE
P_BIRTH_DATE
BIRTH_DATE
Diagnosis details
(Additional explanatory text describing diagnosis of the patient)
P_DIAG_TEXT
Institution
(Identification of an institution, usually refers to a receiving or sending regsitry.)
INST_ID
Contact phone number
(The listed phone number to contact at an organisation usually a registry or transplant centre)
PHONE
Donor Identification ( to be replaced by GRID)
(Donor Idenitification assigned by donor registry)
D_ID
ID
First name
(Given name of an individual)
P_FNAME
Patient Identification
(Patient identification assigned by patient registry)
P_ID
RSV_PAT
Last name
(Surname of an individual)
P_LNAME