| Name | F40 |
| Description | Prescription for Stem Cell and Lymphocyte Collection (2x as one whole form) |
| Name of field on form | Dictionary label (description) | EMDIS fields (matching dictionary field) | WMDA XML fields (matching dictionary field) |
|---|---|---|---|
| - |
Required Anticoagulant (Type of anticoagulant) |
ANTI_COAG |
|
| - |
Required CD34+/kg (Requested number of CD34+ cells per kilo for recipient) |
CD34PC_KG |
|
| - |
Required CD3+/kg (Requested number of CD3+ cells per kilo for recipient) |
CD3PC_KG |
|
| - |
Mononuclear cells per kilogram (The number of mononuclear cells per patient kilo. Workup request for future implementation in EMDIS.) |
MONO_NC_KG |
|
| PRE-COLLECTION ADDITIONAL SAMPLES: Sample type: |
Blood sample requirements (tube type) (The type of peripheral blood samples (tube & anticoagulant)) |
PROD1 PROD1_ATCOL PROD1_BEFCOL PROD2 PROD2_ATCOL PROD2_BEFCOL PROD3 PROD3_ATCOL PROD3_BEFCOL PROD4 PROD4_ATCOL PROD4_BEFCOL |
|
| PRE-COLLECTION ADDITIONAL SAMPLES: mL |
Blood sample requirements (amount) (The amount (volume) of peripheral blood samples) |
NBT1 NBT1_ATCOL NBT1_BEFCOL NBT2 NBT2_ATCOL NBT2_BEFCOL NBT3 NBT3_ATCOL NBT3_BEFCOL NBT4 NBT4_ATCOL NBT4_BEFCOL QU1 QU2 QU3 QU4 QUANT1_ATCOL QUANT1_BEFCOL QUANT2_ATCOL QUANT2_BEFCOL QUANT3_ATCOL QUANT3_BEFCOL QUANT4_ATCOL QUANT4_BEFCOL |
|
| - |
Number of nucleated cells per kilo (Total number of nucleated cells per kilo for recipient) |
NC_KG |
|
| - |
Preferred date (collection/shipment) 1 (First preferred date for collection / CBU shipment per TC) |
PROP_DATE |
|
| - |
Product request (Requesting TC/registry's product preference) |
WOR_REQ_TYPE |
|
| - |
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 |
|
| - |
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 |
|
| - |
Weight (Weight measured in kilograms) |
D_WEIGHT P_WEIGHT |
WEIGHT |
| - |
Postal Code (Postal code (or zip code) of an address) |
ZIP |
|
| - |
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 |