WMDA form: F40

Name F40
Description Prescription for Stem Cell and Lymphocyte Collection (2x as one whole form)

Dictionary Fields

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)
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
(Post code of an organisation such as a registry or TC)
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