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CTS600F01 For Autologous Use Only Community Tissue Services Dayton, OH 45402AUTOLOGOUS DONOR FOR AUTOLOGOUS USE Outpatient Name:___Age:___ Patient MR/ID#___Sex:___ Hospital: ___ # of Specimens in
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Obtain the necessary forms from the community tissue services organization.
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Fill out the forms completely and accurately, providing all required information.
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Submit the completed forms to the community tissue services organization either in person or by mail.
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Who needs community tissue services?

01
Individuals in need of tissue transplants for medical procedures.
02
Medical professionals who perform surgeries and rely on tissue donations.
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Community tissue services refer to the services provided by organizations or facilities that recover and process tissue from deceased donors for transplantation.
Healthcare facilities and organizations that recover and process tissue from deceased donors for transplantation are required to file community tissue services.
Community tissue services can be filled out by providing detailed information about the tissue recovery and processing procedures, the number of donors, and the types of tissues recovered.
The purpose of community tissue services is to ensure the safe and effective recovery and processing of tissue from deceased donors for transplantation purposes.
Information such as the number of donors, types of tissues recovered, tissue processing procedures, and any complications or adverse events must be reported on community tissue services.
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