FDA Regulations and AlloSource Standards require tissue tracking systems in all hospitals using allograft tissue for transplantation. In order to comply with these requirements, please complete ALL fields on this form. Please note, once the lot number is entered, hospital data should automatically populate. If there is an issue with the form, please call 720. 873. 0213.

Alternatively, you may mail your form to the following address:

AlloSource
6278 S Troy Cir
Centennial, CO 80111
ATTN: BILL SHILKUS
Or via fax: 720-873-0207

Please enter a number from 1111111111 to 9999999999.
Hospital/ASC Address
Lot Disposition(Required)
MM slash DD slash YYYY