WMDA forms

Currently available version: 20181207. Document with the latest changes on WMDA template forms can be found here.

WMDA has developed template forms that organisations can use to cover the initial search process through the delivery of stem cell at the transplant facility. Find all forms available on this page.

The WMDA strongly recommends using an up to date PDF reader. Please do not use the forms in your web browser since some WMDA form functions e.g. the GRID calculation check and the signature block will not work. In case you would like to have advice on which PDF reader programme you should use, please contact mail@wmda.info.

Search/ HLA-typing

S10	Preliminary Search Request
S20	Request for Extended Donor HLA Typing
S30	Donor Extended Typing Test Results
S40	Blood Sample request for Verification Typing
S50	Notification of Verification Typing Sample Shipment
S60	Donor HLA Verification Typing Results
S70	Discrepant Typing Report

Formal Request for HPC, Marrow and/ or HPC, Apheresis

F10	Formal Request for Stem Cell or Lymphocyte Collection
F30	Final Compatibility Test Results

Formal Request for T-cells, Apheresis

F10	Formal Request for Stem Cell or Lymphocyte Collection
F20	Previous Transplant History

Formal Request for 2nd transplant- same recipient and same donor (HPC, Marrow and/ or HPC, Apheresis)

F10	Formal Request for Stem Cell or Lymphocyte Collection
F20	Previous Transplant History

Formal Request for 2nd transplant- same recipient and alternative donor

F10	Formal Request for Stem Cell or Lymphocyte Collection
F20	Previous Transplant History
F30	Final Compatibility Test

Request for HPC, Cord

CB10	Cord Blood Unit – Information and Typing Request
CB21	HPC, Cord Blood Unit Report
CB30	Cord Blood Unit Shipment Request

Forms used by Donor Center/ Collection Centre

F50	IDM Testing to be Performed During Donor Workup
F70	Verification of Cell Product
F80	Notification of Donor Clearance
C10	Collection Report
C20	Abnormal Donor Finding Letter
C30	Notification unable to clear

Forms related to Transport

T10	Courier & emergency contact information during stem cell transportation
T20	Emergency Stem Cell Storage Directions
T30	Transport of Stem Cell Product Audit
T40	Courier Letter
T50	Proforma Invoice

Forms related to Donor Follow-up

DF1	Donor Assessment Post Stem Cell Donation
DF3	Annual Donor Assessment Post Stem Cell Donation

Request for Patient’s Sibling Service

F90	Request for Patient’s Siblings Service

Transplant Follow Up

TF1	Stem Cell Transplantation Follow-up (3 months after transplantation)
TF2	Stem Cell Transplantation Follow-up (year(s) after transplantation)

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