Stem cell forms

The majority of these forms are PDFs and require Adobe Acrobat Reader 

Collection, testing and storage

• 5110: Therapeutic Apheresis Services request for collection of stem cells, lymphocytes or white cells (if you use Internet Explorer highlight the link, right click and select 'Save target as' to download)
• 5071:  request to collect and process stem cell and immunotherapy products (if you use Internet Explorer highlight the link, right click and select 'Save target as' to download)
• INF1243: referral of patients for stem cell collection and processing
  
• 2B: consent for the testing, storage and discard of stem cells or lymphocytes
  
• 2K: guidance for healthcare professionals in consenting for the testing, storage and discard of stem cells or lymphocytes 

Cord blood collection 

• 2C: request for directed collection
• 2D: consent for directed collection, testing and cryopreservation
• 2L: guidance for healthcare professionals in consenting for the collection, testing and cryopreservation for directed transplantation
• 2R: information for mothers regarding directed cord blood collection 

Issue of cryopreserved products

• 2F: request for issue of products
• 2G: engraftment report: 30 days post stem cell transplantation
• 2H: clinical outcome report: 100 days post donor lymphocyte infusion

Transfer and returns 

• 2M: record of transfer of products between institutions 
• 2N: stem cell product return

Request for discard

• 1960: request for authorisation to discard a HPC or other cellular therapy product (if you use Internet Explorer highlight the link, right click and select 'Save target as' to download)