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
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)