38 Kidney Transplant Recipient Follow Up Post 5 Year_Form.x

TRF - Kidney - Adult
Fields to be completed by members					Fields to be completed by members
Form Section	Field label	Notes		Form Section	Field label	Notes
1-Recipient Information	Organ Type	Display Only - Cascades from Database		1-Recipient Information	Organ Type	Display Only - Cascades from Database
1-Recipient Information	Follow up code	Display Only - Cascades from Database		1-Recipient Information	Follow up code	Display Only - Cascades from Database
1-Recipient Information	Recipient First Name	Display Only - Cascades from TCR		1-Recipient Information	Recipient First Name	Display Only - Cascades from TCR
1-Recipient Information	Recipient Last Name	Display Only - Cascades from TCR		1-Recipient Information	Recipient Last Name	Display Only - Cascades from TCR
1-Recipient Information	Recipient Middle Initial	Display Only - Cascades from TCR		1-Recipient Information	Recipient Middle Initial	Display Only - Cascades from TCR
1-Recipient Information	SSN	Display Only - Cascades from TCR		1-Recipient Information	SSN	Display Only - Cascades from TCR
1-Recipient Information	HIC	Display Only - Cascades from TCR		1-Recipient Information	HIC	Display Only - Cascades from TCR
1-Recipient Information	Previous Follow-Up	Display Only - Cascades from prior TRF		1-Recipient Information	Previous Follow-Up	Display Only - Cascades from prior TRF
1-Recipient Information	DOB	Display Only - Cascades from TCR		1-Recipient Information	DOB	Display Only - Cascades from TCR
1-Recipient Information	Gender	Display Only - Cascades from TCR		1-Recipient Information	Gender	Display Only - Cascades from TCR
1-Recipient Information	Tx Date	Display Only - Cascades from Database		1-Recipient Information	Tx Date	Display Only - Cascades from Database
1-Recipient Information	Previous Px Stat Date	Display Only - Cascades from prior TRF		1-Recipient Information	Previous Px Stat Date	Display Only - Cascades from prior TRF
1-Recipient Information	Transplant Discharge Date			1-Recipient Information	Transplant Discharge Date
1-Recipient Information	State of Permanent Residence			1-Recipient Information	State of Permanent Residence
1-Recipient Information	Zip Code			1-Recipient Information	Zip Code
2-Provider Information	Recipient Center	Display Only - Cascades from TCR		2-Provider Information	Recipient Center	Display Only - Cascades from TCR
2-Provider Information	Recipient Center Type	Display Only - Cascades from TCR		2-Provider Information	Recipient Center Type	Display Only - Cascades from TCR
2-Provider Information	Followup Center Code	Display Only - Cascades from Database		2-Provider Information	Followup Center Code	Display Only - Cascades from Database
2-Provider Information	Followup Center Type	Display Only - Cascades from Database		2-Provider Information	Followup Center Type	Display Only - Cascades from Database
3-Donor Information	UNOS Donor ID #	Display Only - Cascades from Database		3-Donor Information	UNOS Donor ID #	Display Only - Cascades from Database
3-Donor Information	Donor Type	Display Only - Cascades from Database		3-Donor Information	Donor Type	Display Only - Cascades from Database
3-Donor Information	OPO	Display Only - Cascades from feedback		3-Donor Information	OPO	Display Only - Cascades from feedback
4-Patient Status at Time of Follow-Up	Date: Last Seen, Retransplanted or Death			4-Patient Status at Time of Follow-Up	Date: Last Seen, Retransplanted or Death
4-Patient Status at Time of Follow-Up	Patient Status			4-Patient Status at Time of Follow-Up	Patient Status
4-Patient Status at Time of Follow-Up	Primary Cause of Death			4-Patient Status at Time of Follow-Up	Primary Cause of Death
4-Patient Status at Time of Follow-Up	Primary Cause of Death//Specify			4-Patient Status at Time of Follow-Up	Primary Cause of Death//Specify
5-Clinical Information	Graft Status			4-Patient Status at Time of Follow-Up	Functional Status
5-Clinical Information	If Functioning, Most Recent Serum Creatinine			4-Patient Status at Time of Follow-Up	Cognitive Development
5-Clinical Information	If Functioning, Most Recent Serum Creatinine//Status	Value or status is reported, not both		4-Patient Status at Time of Follow-Up	Motor Development
5-Clinical Information	Date of Graft Failure:			5-Clinical Information	Date of Measurement
5-Clinical Information	Primary Cause of Graft Failure:			5-Clinical Information	Height
5-Clinical Information	Primary Cause of Graft Failure//Other, Specify:			5-Clinical Information	Height//Status	Value or status is reported, not both
5-Clinical Information	Post Transplant Malignancy			5-Clinical Information	Height Percentile	Calculated for display only
5-Clinical Information	Donor Related			5-Clinical Information	Weight
5-Clinical Information	Recurrence of Pre-Tx Tumor			5-Clinical Information	Weight//Status	Value or status is reported, not both
5-Clinical Information	Post Tx De Novo Solid Tumor			5-Clinical Information	Weight Percentile	Calculated for display only
5-Clinical Information	De Novo Lymphoproliferative disease and Lymphoma			5-Clinical Information	BMI	Display Only - Cascades from Database
				5-Clinical Information	BMI	Calculated for display only
	Public Burden Statement			5-Clinical Information	Kidney Graft Status
				5-Clinical Information	If Functioning, Most Recent Serum Creatinine
				5-Clinical Information	If Functioning, Most Recent Serum Creatinine//Status	Value or status is reported, not both
				5-Clinical Information	Kidney Date of Graft Failure:
				5-Clinical Information	Primary Cause of Graft Failure:
				5-Clinical Information	Primary Cause of Graft Failure//Other, Specify:
				5-Clinical Information	New diabetes onset between last follow-up to the current follow-up
				5-Clinical Information	If yes, insulin dependent
				5-Clinical Information	Coronary Artery Disease Since Last Follow Up
				5-Clinical Information	Post Transplant Malignancy
				5-Clinical Information	Donor Related
				5-Clinical Information	Recurrence of Pre-Tx Tumor
				5-Clinical Information	Post Tx De Novo Solid Tumor
				5-Clinical Information	De Novo Lymphoproliferative disease and Lymphoma
					Public Burden Statement