50 Vascular Composite Allograft (VCA) Transplant Candidate

		TCR - VCA - Adult/Ped
		Fields to be completed by members
		Form Section	Field Label	Notes
		1-Provider Information	Candidate Center:	Display Only - Cascades from Waitlist
		2-Candidate Information	Organ Registered:	Display Only - Cascades from Waitlist
		2-Candidate Information	Listing Date:	Display Only - Cascades from Waitlist
		2-Candidate Information	Last Name:	Display Only - Cascades from Waitlist
		2-Candidate Information	First Name:	Display Only - Cascades from Waitlist
		2-Candidate Information	Middle Initial:	Display Only - Cascades from Waitlist
		2-Candidate Information	SSN:	Display Only - Cascades from Waitlist
		2-Candidate Information	Date of Birth:	Display Only - Cascades from Waitlist
		2-Candidate Information	Gender:	Display Only - Cascades from Waitlist
		2-Candidate Information	Ethnicity/Race:	Display Only - Cascades from Waitlist
		5-Clinical Information	Height (in)	Display Only - Cascades from Waitlist
		5-Clinical Information	Weight (lbs)	Display Only - Cascades from Waitlist
		5-Clinical Information	ABO Blood Group:	Display Only - Cascades from Waitlist
			Public Burden Statement