§2800.APPENDIX C. Addendum II - Facility Experience

FACILITY:
TYPE OF TRANSPLANT:
PERIOD COVERED*:
PATIENT**	AGE	DISEASE			TRANSPLANT DATE	RETRANSPLANT		STATUS

 

 

*All patients in most recent twelve-month period.

**If funded by Experimental Organ Transplantation Program, indicate patient's name; otherwise use identifier only.

 

(Source:  Added at 12 Ill. Reg. 15550, effective September 16, 1988)