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 1.1.15
Release Date: January 04, 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.

04/30/2020COVID-19 Patient Enrollment Form: For transplanted patients not enrolled in PHTSAt time of infection
01/04/2021Form 6C: Infection COVID-19 and MIS-CAt time of infection pre OR post transplant
01/04/2021COVID-19 Data Entry Manual 
01/30/2020Patient EnrollmentAt time of enrolling patient into PHTS
01/03/2020Form 1: Initial Patient Entry at ListingAt time of listing
06/08/2020Form 1RL: Patient RelistingAt time of re-listing
01/03/2020Form 1T: Transplant InformationAt time of transplant
7/29/2019Form 2: DonorAt time of transplant
10/23/2017Form 3: Initial Immunosuppression & Antibiotics30 days post-transplant
11/04/2019 Form 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
09/28/202010 Form 8 (Post Tx Annual Follow-up)Annually 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
06/08/2020Form 12: Pre-Transplant Follow-upAnnually pre-transplant
01/03/2020Form 14: Dialysis/Renal TransplantAt time of event post-listing OR post-transplant
01/04/2021 Form 15: Mechanical Circulatory Support EventsAt time of event post-listing OR post-transplant
01/04/2021Version 1.1.15 Final Manual