FDA Tissue Tracking

Completion of this record at the time of graft usage is required by FDA regulations. FDA requires patient records to be properly maintained by storing the allograft LOT NUMBER for purposes of tracking the allograft from the donor to the recipient. We ask that your facility act responsibly by providing the information below and maintaining a copy in the patient file. Upon completion you will receive an email confirmation that includes the information provided.

Gomez Meda Course Form

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Section 1: Information

Speciality
Credentials
AGD Member # (put N/A if not an AGD Member)

Section 2: Registration Fees

Section 3: Payment Information

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
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