COG Patient Checklist - Institute of Cancer Research

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Childhood Overgrowth (COG) study
Recruitment checklist
(version 1 / June 2009)
Patient Name………………………………………………………………………
Patient dob…………………………………………………………………………
Your reference ID………………………………………………………………….
1. Information sheet given to family

2. Completed questionnaire

3. Copies of clinic letters

4. Copies of molecular reports

5. Photographs

6. Pedigree if there is a relevant family history

7. Informed consent (enclose copy)

8. Samples
9-18ml blood (EDTA) / DNA sample from patient

9-18ml blood (EDTA) / DNA sample from mother

9-18ml blood (EDTA) / DNA sample from father

Ideally 2x 9ml bottles, but we will include patients from whom less is available;
please send samples from both parents if available, but we will include patients
without parental samples.
PLEASE SEND SAMPLES AND FORMS BY FIRST-CLASS POST
TO: (PRE-PAID ADDRESS LABELS ARE AVAILABLE)
Professor Nazneen Rahman
Section of Cancer Genetics,
Institute of Cancer Research,
15 Cotswold Road,
Sutton, Surrey,
SM2 5NG.
Queries: Margaret Warren-Perry
Tel. 020 8722 4377/4099
Fax. 020 8722 4359
Email [email protected]
Please complete and return this form with the samples and clinical information
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