Specimen Processing Services Form (Word)

advertisement
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
Download
Related flashcards
Photosynthesis

38 Cards

Animal cells

11 Cards

Proteins

78 Cards

Enzymes

92 Cards

Mitosis

29 Cards gattwik

Create flashcards