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 1.1.26
Release Date: August 18th, 2023
*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.

01/30/2020Patient EnrollmentAt time of enrolling patient into PHTS
08/18/2023Form 1: Initial Patient Entry at ListingAt time of listing
08/01/2022Form 1RL: Patient RelistingAt time of re-listing
08/18/2023Form 1T: Transplant InformationAt time of transplant
05/28/2021Form 2: DonorAt time of transplant
10/23/2017Form 3: Initial Immunosuppression & Antibiotics30 days post-transplant
06/22/2023Form 4: Coronary EvaluationAt time of event post-transplant
08/01/2022Form 5: RejectionAt time of event post-transplant
06/22/2023Form 6: InfectionAt time of event post-transplant
06/22/2023Form 7: Malignancy Lymphoproliferative DisorderAt time of event post-transplant
08/18/2023Form 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
06/22/2023Form 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
06/22/2023Form 18: Donor Derived Cell-Free DNA Collection At time of event post-transplant
08/18/2023Version 1.1.26 Final Manual