M
D
S
Molecular Diagnostic Services, Inc.
Phone: (858) 450-9990; Fax: (858) 450- 0619; E-mail: services@mds-usa.com
Tissue Cross Reactivity (TCR) of a Monoclonal Antibody (X)
Please print and complete this form and forward/fax to MDS. We will contact you for a detailed quotation.
Institution:
Email:
Billing Address:
Submitted by:
Shipping Address:
Zip:
Fax:(
)
-
Investigator:
Date Submitted:
State:
Phone:(
)
/
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PO #:
City:
Ext:
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A: Sources of Antibody
Full name of Antibody
Manufacturer
Volume provided
, Concentration mg
Recommended storage Temp.
/mL
Preservative if applicable
B: Tissue selection: Indicate (check box) Normal Tissues to be included in IHC Testing
Central Nervous System:
Brain, Cerebrum
Cerebral Cortex
Brain, Cerebellum
Spinal cord
Peripheral Nerve (Optional)
Glands :
Adrenal
Ovary
Pancreas
Parathyroid
Pituitary (Optional)
Thymus
Prostate
Testis
Thyroid (follicular epithelium,
parafollicular cells, colloid, etc.)
Breast:
Breast
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M
D
S
Molecular Diagnostic Services, Inc.
Phone: (858) 450-9990; Fax: (858) 450- 0619; E-mail: services@mds-usa.com
Hematopoietic:
Spleen
Tonsil
Thymus
Bone marrow
Respiratory:
Lung
Cardiovascular:
Heart
Gastrointestinal Tract:
Esophagus
Stomach
Small intestine
Colon
Liver
Salivary Gland
Kidney
Prostate
Uterus
Bladder
Cervix
Fallopian tube
Ureter
Uterus-cervix
uterus-endometrium
Musculoskeletal:
Skeletal muscle
Skin (epidermis, appendages,
dermis)
Placenta
Lymph node
Mesothelial cells:
Lining cells from chest wall, abdominal wall, pericardium or from the surface of
gastrointestinal, heart and/or lung samples
Other:
Please List (Please Limit Your Comments to 300 characters):
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