Appendix D
Unique ID Assignment Form (CRID), Form 2804
In order to generate a Unique ID (CRID) the following fields must be answered
on the Form 2804:
Autologous HSCT
Key Fields: CIBMTR Center # and Today’s Date
Question 1: For autologous HSCTs only: Has the recipient consented for research?
If yes, follow rules for allogeneic HSCT
If no, complete the following questions:
Question 4: Recipient date of birth (year of birth only)
Question 15: Primary disease for which the HSCT would be performed
Question 16: Tentative HSCT date
Question 17: Cell source for the HSCT
Question 18: Has the recipient undergone a previous HSCT?
If yes, complete questions 19-26
If no, continue with question 27
Question 19: Date of first HSCT
Questions 20-23: Cell source for first HSCT
Questions 24-26: Product type for first HSCT
Question 27: Person completing the form
NOTE:
If an autologous HSCT recipient declines to participate in research, the Form 2804 is
the only form that must be submitted to the CIBMTR.
Allogeneic HSCT
Key Fields: CIBMTR Center # and Today’s Date
Question 4: Recipient date of birth (year of birth only)
Question 8: Recipient gender
Question 9: Recipient SSN, if applicable or, if center is able to report
Question 10: Recipient NMDP ID, if applicable
Question 11: Recipient EBMT ID, if applicable
Question 12: Recipient IUBMID (former CIBMTR #), if applicable
Question 13: Team # (former CIBMTR Team #), if applicable
Question 15: Primary disease for which the HSCT would be performed
Question 16: Tentative HSCT date
Question 17: Cell source for the HSCT
Question 18: Has the recipient undergone a previous HSCT?
If yes, complete questions 19-26
If no, continue with question 27
Question 19: Date of first HSCT
Questions 20-23: Cell source for first HSCT
Questions 24-26: Product type for first HSCT
Question 27: Person completing the form
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National Marrow Donor Program and The Medical College of Wisconsin
Document Title: CIBMTR Forms Manual: Appendix D - Unique ID Assignment Form (CRID), Form 2804
Document Number: A00379 version 2
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