RCMI CENTER FOR GENOMICS IN HEALTH DISPARITIES AND RARE DISEASES SPECIMEN PROCESSING SERVICES Drop-off Date: ____/____/_____ PRINCIPAL INVESTIGATOR ____________ , ___________ Technician ___________________________ (Last Name) (First Name) Technician E-mail _______________________________ Technician Phone _____________________ EXTRACTION SERVICES WHAT IS TO BE EXTRACTED: DNA RNA Both (If you do not make a selection, your samples will not be processed.) Please indicate any MG Lab downstream applications to be run (example: Microarray, SNP analysis, etc.): ____________________________________________________________________________________ SAMPLES SHOULD BE: Returned to PI Banked by CGHDRD (charges apply) (If banking is NOT selected, samples remaining at the MG Lab will be discarded 30 days after process completion.) Sample Type Whole Blood: Other: Fresh Mouthwash Frozen Tube Type: ___________________ Volume (ml): ___________ Buccal Swab Saliva Tissue: Type _______________________ Size _____________ Storage Method ________________ NUCLEIC ACID ASSESSMENT SERVICES Any material in excess of that required for the services requested will be discarded unless prior specific arrangements have been made with the GPCL. Samples stored over 30 days will incur banking fees. DNA (Use space at bottom for any further information) Whole Genome Amplification: From DNA Quantitation: DNA Spec Qualitation: DNA Agilent Bioanalyzer: From Cells High Sensitivity Other DNA 1000 RNA (Use space at bottom for any further information) Quantitation: RNA Spec Qualitation: RNA Agilent Bioanalyzer: Pico Chip Nano Chip Sample Names and Additional Notes (Include cell number, quantity, concentration, if submitting for Bioanalyzer. Attach a form if needed. Please provide information on any biosafety concerns relevant to the sample(s) submitted for processing.) _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Our postal address is as follows: Molecular Genetics Facility Department of Biochemistry room A-638 P.O. Box 365067 San Juan, Puerto Rico 00936-5067