8 Heart Transplant Recipient Follow Up 6 Month_Form.xlsx

			TRF (6-Month) - Heart - Pediatric
	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	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	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	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 Type	Display Only - Cascades from TCR		2-Provider Information	Recipient Center Type	Display Only - Cascades from TCR
	2-Provider Information	Recipient Center	Display Only - Cascades from TCR		2-Provider Information	Recipient Center	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	Date: Last Seen, Retransplanted or Death			4-Patient Status	Date: Last Seen, Retransplanted or Death
	4-Patient Status	Patient Status			4-Patient Status	Patient Status
	4-Patient Status	Primary Cause of Death			4-Patient Status	Primary Cause of Death
	4-Patient Status	Primary Cause of Death//Specify			4-Patient Status	Primary Cause of Death//Specify
	4-Patient Status	Contributory Cause of Death	Not required		4-Patient Status	Contributory Cause of Death	Not required
	4-Patient Status	Contributory Cause of Death//Specify	Not required		4-Patient Status	Contributory Cause of Death//Specify	Not required
	4-Patient Status	Contributory Cause of Death	Not required		4-Patient Status	Contributory Cause of Death	Not required
	4-Patient Status	Contributory Cause of Death//Specify	Not required		4-Patient Status	Contributory Cause of Death//Specify	Not required
	5-Clinical Information	HIV Serology			5-Clinical Information	HIV Serology
	5-Clinical Information	HIV NAT			5-Clinical Information	HIV NAT
	5-Clinical Information	HbsAg			5-Clinical Information	HbsAg
	5-Clinical Information	HBV DNA			5-Clinical Information	HBV DNA
	5-Clinical Information	HBV Core Antibody			5-Clinical Information	HBV Core Antibody
	5-Clinical Information	HCV Serology			5-Clinical Information	HCV Serology
	5-Clinical Information	HCV NAT			5-Clinical Information	HCV NAT
	5-Clinical Information	Heart Graft Status			5-Clinical Information	Heart Graft Status
	5-Clinical Information	Heart Date of Graft Failure			5-Clinical Information	Heart Date of Graft Failure
	5-Clinical Information	Heart Primary Cause of Graft Failure			5-Clinical Information	Heart Primary Cause of Graft Failure
	5-Clinical Information	Heart Primary Cause of Graft Failure//Other, Specify			5-Clinical Information	Heart Primary Cause of Graft Failure//Other, Specify
					5-Clinical Information	Most Recent Anti-A Titer
		Public Burden Statement			5-Clinical Information	Most Recent Anti-A Titer//Sample Date
					5-Clinical Information	Most Recent Anti-B Titer
					5-Clinical Information	Most Recent Anti-B Titer//Sample Date
						Public Burden Statement