C-2319222 Attachment B - Blue Distinction Centers for Transplant (BDCT) 2026

1. Click ‘Get Form’ to open the C-2319222 Attachment B in the editor.
2. Begin by entering the date at the top of the form. Use the tab key to navigate through each field efficiently.
3. Indicate whether the patient is a FEP Member or Non-FEP Member by checking the appropriate box.
4. Fill in your name, institution, and contact information in the 'From' section.
5. Provide patient details including their name, ID number, and date of birth in the designated fields.
6. Select the type of solid organ transplant and specify if it is an initial transplant or re-transplant by checking the relevant boxes.
7. Complete all applicable dates for pre-transplant periods, inpatient admission, and transplant dates as required.
8. For bone marrow/stem cell transplants, check all applicable diagnoses and fill in mobilization therapy dates as needed.

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