CTR Forms

The following forms are used for routine CTR reporting:


Forms	Dated
Database Edit Form Used for changes to CTR data	Oct 2024
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.