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The following forms are used for routine CTR reporting:

   
Forms
Dated

Database Edit Form

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

Please email This email address is being protected from spambots. You need JavaScript enabled to view it. to order.