17 Post Transplant Malignancy Form_All Organs.xlsx

	Post Transplant Malignancy Form (PTM) - All Organs
	Fields to be completed by members
	Form Section	Field Label	Notes
	1-Recipient Information	Recipient last name	Display Only - Cascades from Database
	1-Recipient Information	Recipient first name	Display Only - Cascades from Database
	1-Recipient Information	Recipient Middle Initial	Not required
	1-Recipient Information	Date of birth	Display Only - Cascades from Database
	1-Recipient Information	Recipient SSN	Display Only - Cascades from Database
	1-Recipient Information	Recipient organ	Display Only - Cascades from Database
	1-Recipient Information	TRF	Display Only - Cascades from Database
	1-Recipient Information	Follow-up code	Display Only - Cascades from Database
	1-Recipient Information	Transplant date	Display Only - Cascades from Database
	1-Recipient Information	Follow-up Center Code	Display Only - Cascades from Database
	1-Recipient Information	Follow-up Center Type	Display Only - Cascades from Database
	1-Recipient Information	Followup Center	Display Only - Cascades from Database
	1-Recipient Information	Transplant Center Code	Display Only - Cascades from Database
	1-Recipient Information	Transplant Center Type	Display Only - Cascades from Database
	1-Recipient Information	Transplant Center	Display Only - Cascades from Database
	2-Donor Related	Diagnosis date:
	2-Donor Related	Tumor type:
	2-Donor Related	Tumor Types: Skin: //squamous cell:
	2-Donor Related	Tumor Types: Skin: //basal cell:
	2-Donor Related	Tumor Types: Skin: //melanoma:
	2-Donor Related	Tumor Types: //Kaposi's sarcoma: cutaneous:
	2-Donor Related	Tumor Types: //Kaposi's sarcoma: visceral:
	2-Donor Related	Tumor Types: //Brain:
	2-Donor Related	Tumor Types: Brain: //Other specify:
	2-Donor Related	Tumor Types: //Renal carcinoma - specify site(s):
	2-Donor Related	Tumor Types: //Carcinoma of vulva, perineum or penis, scrotum:
	2-Donor Related	Tumor Types: //Carcinoma of the uterus:
	2-Donor Related	Tumor Types: //Ovarian:
	2-Donor Related	Tumor Types: //Testicular:
	2-Donor Related	Tumor Types: //Esophagus:
	2-Donor Related	Tumor Types: //Stomach:
	2-Donor Related	Tumor Types: //Small intestine:
	2-Donor Related	Tumor Types: //Pancreas:
	2-Donor Related	Tumor Types: //Larynx:
	2-Donor Related	Tumor Types: //Tongue, throat:
	2-Donor Related	Tumor Types: //Thyroid:
	2-Donor Related	Tumor Types: //Bladder:
	2-Donor Related	Tumor Types: //Breast:
	2-Donor Related	Tumor Types: //Prostate:
	2-Donor Related	Tumor Types: //Colo-rectal:
	2-Donor Related	Tumor Types: //Primary hepatic tumor:
	2-Donor Related	Tumor Types: //Metastatic liver tumor:
	2-Donor Related	Tumor Types: //Lung:
	2-Donor Related	Tumor Types://Leukemia:
	2-Donor Related	Tumor Types: //Sarcomas:
	2-Donor Related	Tumor Types: //Other cancers:
	2-Donor Related	Other Cancers: //Site(s):
	2-Donor Related	Tumor Types: //Primary unknown:
	3-Recurrence of Pretransplant Malignancy	Type of pre-existing tumor:
	3-Recurrence of Pretransplant Malignancy	If other cancer, specify:
	3-Recurrence of Pretransplant Malignancy	Date of recurrence (post tx):
	4-Post Transplant De Novo Solid Tumor	Tumor Types: Skin: //squamous cell:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: Skin: //basal cell:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: Skin: //melanoma:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Kaposi's sarcoma: cutaneous:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Kaposi's sarcoma: visceral:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Brain:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: Brain: //Other specify:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Renal carcinoma - specify site(s):
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Carcinoma of vulva, perineum or penis, scrotum:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Carcinoma of the uterus:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Ovarian:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Testicular:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Esophagus:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Stomach:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Small intestine:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Pancreas:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Larynx:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Tongue, throat:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Thyroid:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Bladder:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Breast:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Prostate:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Colo-rectal:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Primary hepatic tumor:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Metastatic liver tumor:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Lung:
	4-Post Transplant De Novo Solid Tumor	Tumor Types://Leukemia:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Sarcomas:
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Other cancers:
	4-Post Transplant De Novo Solid Tumor	Other Cancers: //Site(s):
	4-Post Transplant De Novo Solid Tumor	Tumor Types: //Primary unknown:
	4-Post Transplant De Novo Solid Tumor	Diagnosis date
	5-Post Transplant Lymphoproliferative Disease and Lymphoma	PTLD: //Diagnosis date:
	5-Post Transplant Lymphoproliferative Disease and Lymphoma	PTLD: //Pathology:
	5-Post Transplant Lymphoproliferative Disease and Lymphoma	PTLD: Pathology: //Other Specify:
		Public Burden Statement