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T10COURIER & EMERGENCY CONTACT INFORMATION DURING STEM CELL TRANSPORTATION Page 1 of 2PATIENT DATA Patient name: Transplant center: Patient registry: Patient ID: (assigned by patient registry) DONOR

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How to fill out autologous stem cell transplant

01

Consult with your healthcare provider to determine if autologous stem cell transplant is the best treatment option for you

02

Undergo a series of tests to ensure you are a suitable candidate for the procedure

03

Receive a conditioning regimen of high-dose chemotherapy to destroy cancerous cells and prepare your body for the transplant

04

Undergo the actual stem cell transplant, where stem cells are collected from your own body and reintroduced after chemotherapy

05

Follow up with your healthcare provider for monitoring and recovery post-transplant

Who needs autologous stem cell transplant?

01

Patients with certain types of cancer, such as lymphoma or multiple myeloma, may benefit from autologous stem cell transplant as a treatment option

02

Individuals with certain autoimmune diseases, such as multiple sclerosis, may also be candidates for autologous stem cell transplant

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What is autologous stem cell transplant?

An autologous stem cell transplant is a medical procedure in which stem cells are harvested from a patient's own body, typically from their bone marrow or blood, and then reintroduced after intensive treatment such as chemotherapy or radiation.

Who is required to file autologous stem cell transplant?

Patients undergoing autologous stem cell transplants, as well as the healthcare providers performing the procedures, may need to file relevant documentation for insurance purposes or medical records.

How to fill out autologous stem cell transplant?

To fill out the necessary documentation for an autologous stem cell transplant, the patient and healthcare provider should provide detailed information including medical history, treatment plans, and stem cell collection methods, according to the specific forms required by their healthcare system.

What is the purpose of autologous stem cell transplant?

The purpose of an autologous stem cell transplant is to restore the patient's bone marrow function after it has been damaged by disease or treatment, allowing for the recovery of healthy blood cells.

What information must be reported on autologous stem cell transplant?

Information that must be reported includes the patient's medical history, stem cell source, quantity harvested, transplant procedure details, and post-transplant recovery progress.

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