Current Data Collection Forms

PHTS launched a Web Based Data Entry System on November 4, 2015 at the annual meeting in Orlando, Florida. Data collection forms used in the live system can be found below.

Data Collection Forms: Version 1.1.17
Release Date: August 31, 2021
*Every form is not revised in every release on the web based data entry system. The latest update date to each form can be found below.

PHTS is now collecting infection data on COVID-19 and MIS-C infections in transplanted patients.

DateFormTime
05/28/2021COVID-19 Patient Enrollment Form: For transplanted patients not enrolled in PHTSAt time of infection
05/28/2021Form 6C: Infection COVID-19 and MIS-CAt time of infection pre OR post transplant
05/28/2021COVID-19 Data Entry Manual 
DateFormTime
01/30/2020Patient EnrollmentAt time of enrolling patient into PHTS
08/31/2021Form 1: Initial Patient Entry at ListingAt time of listing
08/31/2021Form 1RL: Patient RelistingAt time of re-listing
08/31/2021Form 1T: Transplant InformationAt time of transplant
05/28/2021Form 2: DonorAt time of transplant
10/23/2017Form 3: Initial Immunosuppression & Antibiotics30 days post-transplant
05/28/2021Form 4: Coronary EvaluationAt time of event post-transplant
7/29/2019Form 5: RejectionAt time of event post-transplant
01/03/2020Form 6: InfectionAt time of event post-transplant
01/03/2020Form 7: Malignancy/ Lymphoproliferative DiseaseAt time of event post-transplant
09/28/2020Form 8: Post Tx Annual Follow-upAnnually post-transplant
10/23/2017Form 9: Coronary RevascularizationAt time of event post-transplant
11/04/2019Form 10: DeathAt time of death post-listing OR post-transplant
08/31/2021Form 12: Pre-Transplant Follow-upAnnually pre-transplant
01/03/2020Form 14: Dialysis/Renal TransplantAt time of event post-listing OR post-transplant
01/04/2021Form 15: Mechanical Circulatory Support EventsAt time of event post-listing OR post-transplant
08/31/2021Version 1.1.17 Final Manual