MHC Typing Sample Delivery Form
Contact Information
Principal
Investigator/Lab Contact
Institution
Address
Address
Address
Phone
Fax
E-mail
Send Results to
Name
E-mail
Shipping Contact
Name
Phone
E-mail
Date Shipped
Tracking #
Send Invoice to
Name
Institution
Address
Address
Address
Phone
Fax
E-mail
Department of Pathology
Life Science Technology Park (LSTP), Room 2340
1951 NW 7th Avenue, 2nd Floor (R-12) | Miami, FL 33136
Phone: 305-243-3352
Page 1 of 5
Payment type
____ Credit card
_____ Purchase Order PO #: ___________________________
Number of specimens to be tested ____________
____ Blood (EDTA anti-coagulated) _____Cells (5 x 106, live frozen) _____DNA
Do these samples have any known pathogens? ____ Yes
_____ No
If yes, list pathogens: __________________________________________________
__________________________________________________________________________
Service requested:
_____ Genotyping: tray of 9 class I SIV alleles
(Mamu-A1*001, A1*002, A1*008, A1*011, B*001, B* 003, B*004, B*008, B*017)
_____ Genotyping: tray of 13 class I SIV alleles
(Mamu-A1*001, A1*002, A1*008, A1*011, B*001, B* 003, B*004, B*008, B*017,
B*029, DRBw*201, DRB1*04, DPB1*07:01 formerly DPB1*06)
_____ Other Genotyping: indicate alleles requested
Mamu-A1*001 (subtypes)
Mamu-A1*002
Mamu-A1*007 (subtypes)
Mamu-A1*008
Mamu-A1*011
Mamu-B*001
Mamu-B*003/066
Mamu-B*004/105/106
Mamu-B*006 (subtypes)
Mamu-B*007 (subtypes)
Mamu-B*008
Mamu-B*017 (subtypes)
Mamu-B*022/033
Mamu-B*029 (subtypes)
Mamu-B*030
Mamu-B*046 (subtypes)
Mamu-B*047 (subtypes)
Mamu-B*048 (subtypes)
Mamu-B*052
Mamu-B*055
Mamu-B*058:02
Mamu-B*064 (subtypes)
Mamu-DPB1*06:01 (Mamu-DPB1*02)
Mamu-DPB1*07:01 (Mamu-DPB1*06)
Mamu-DPB1*15:01 (Mamu-DPB1*10)
Mamu-DRB1*03:06 (subtypes)
Mamu-DRB1*03:09
Mamu-DRB1*04 (subtypes)
Mamu-DRB1*10:03 (subtypes)
Mamu-DRB*w201
Mamu-DRB*w606
Mamu-DRB*w2104 group
Department of Pathology
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Life Science Technology Park (LSTP), Room 2340
1951 NW 7th Avenue, 2nd Floor (R-12) | Miami, FL 33136
Phone: 305-243-3352
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Department of Pathology
Life Science Technology Park (LSTP), Room 2340
1951 NW 7th Avenue, 2nd Floor (R-12) | Miami, FL 33136
Phone: 305-243-3352
Page 3 of 5
1.
INSTRUCTIONS FOR SENDING SAMPLES FOR TYPING
Purchase orders must be set up IN ADVANCE with the University of Miami –
Dept. of Pathology and must be included on the Delivery Form. Credit card
payments should be made upon receipt of invoice.
2.
Fill in the Delivery Form completely. This will ensure prompt processing of
your samples and correct reporting of results. Please type sample IDs to ensure
proper identification of samples.
3.
Please note that we DO NOT accept sample delivery on Fridays. Please ship
samples Mon-Wednesday to arrive Tues –Thursday.
4.
Include the sample delivery form with your shipment. Please additionally send
it by e-mail (Tgiret@med.miami.edu) or fax BEFORE you ship out your samples
so that we can prepare to receive your samples and track them if they do not
arrive when expected.
5.
For testing we require (preferably) 2 mL of EDTA anti-coagulated blood. This
should be sent at 4°C in an insulated shipper with cold packs. If you are sending
cells, they must have been live frozen, 5 x 106 nucleated cells (5 x 106/1 ml for
BLCLs, 5 x 106/200 uL for PBMC). Cells must be shipped on dry ice; upon
receipt we will freeze them at -80 until we extract DNA. If necessary we will
accept purified DNA, at a minimum of 100uL @ 25ug/mL, shipped at room
temperature. Note: Our PCR method has been optimized for DNA extracted with
a specific system. We achieve optimal typing results from blood or cells
extracted on this system and discourage clients from shipping DNA samples
extracted by other methods.
Department of Pathology
Life Science Technology Park (LSTP), Room 2340
1951 NW 7th Avenue, 2nd Floor (R-12) | Miami, FL 33136
Phone: 305-243-3352
Page 4 of 5
6.
Ship samples to:
Teresa M Giret, Ph.D.
MHC Typing Core
AIDS Vaccine Research Laboratory
Department of Pathology
University of Miami Miller School of Medicine
Life Science Technology Park (R-12)
1951 NW 7th Ave, 2nd Floor, Room 2340
Miami, Fl. 33136
Phone: (305) 243-3352
mailto: TGiret@med.miami.edu
7.
An electronic copy of the results will be sent to the investigator(s) listed on the
account via e-mail, unless a paper copy is requested.
Department of Pathology
Life Science Technology Park (LSTP), Room 2340
1951 NW 7th Avenue, 2nd Floor (R-12) | Miami, FL 33136
Phone: 305-243-3352
Page 5 of 5