The following forms are used for routine CTR reporting:
Forms |
Dated |
Used for changes to CTR data |
Mar 2011 |
IM.006F - Interhospital Exchange Form (fillable PDF) Used for product shipments without a patient. To order the hard copy forms, see Redistribution Supply Order Form. |
April 2018 |
IM.007F - Interhospital Exchange Form (fillable PDF) Used for blood product transport with a patient To order the hard copy forms, see Redistribution Supply Order Form. |
April 2018 |
IM.003F - Blood Product Issue and Transfusion Record Used to manually report transfusion records |
Apr 2009 |
IM.005F - Component and Fractionated Blood Product Discard Record Used to manually report discarded records |
May 2009 |
The following items are available to order through the PBCO:
• IM.003F Blood Product Issue and Transfusion Record
• IM.005F Component and Fractionated Blood Product Discard Record
• Code C Address Labels
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