2 Zdrave St., 1431 Sofia, Bulgaria;
Tel: (+359) 2 9172 214; Fax: (+359) 2 9172 214 http://www.mmcbg.org
; mmcbg@abv.bg
I. APPLICANT INFORMATION
Name:__________________________________________________________________
Date of submission: _______________________________________
Organization:_____________________________________________________________
Department:______________________________________________________________
Invoice/project number:____________________________________________________
Address: _________________________________________________________________
Phone:
Email:__________________________
II. SAMPLE INFORMATION
Sample ID: ____________________________________________________
Sex: Male

Female

Sample (double stranded genomic DNA) origin:

Blood

Tissue

Other: ______
Sample condition :

Dissolved in water

Dissolved in TE Buffer

In pure ethanol

Dry powder

Other: ___________

Sample concentration in ng/ul
______________________
Total sample amount in ng:
_____________________________
We will provide reagents and consumables Yes

No

If yes, we need support in ordering reagents and consumables Yes

No

If no, we need you to order the reagents and consumables Yes

No

Please indicate clinical diagnosis, symptoms and family history:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Have any genetic tests already been performed? Yes

No

If yes, which? Results?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
III. TEST REQUESTED
 Ion AmpliSeq™ Comprehensive Cancer Panel
(Oncology panel targeting exons within >400 oncogenes and tumor suppressor genes, at least 40 ng per DNA sample is needed)
 Ion AmpliSeq™ Inherited Disease Panel
(Broad inherited disease panel targeting exons of over 300 genes associated with over
700 inherited diseases including neuromuscular, cardiovascular, developmental, and

metabolic diseases, at least 30 ng per DNA sample is needed)
 Ion AmpliSeq™ Cancer Hotspot Panel v2
(Target "hot spot" regions, including ~2,800 COSMIC mutations of 50 oncogenes and tumor suppressor genes, with wide coverage of KRAS, BRAF, and EGFR genes/somatic mutations, at least 10 ng per DNA sample is needed)
 Ion AmpliSeq™ Colon and Lung Cancer Panel
(Contains primer pairs to analyze hotspot and targeted regions of 22 genes implicated in colon and lung cancers, at least 10 ng per DNA sample is needed)
 Ion AmpliSeq™ BRCA1 and BRCA2 Panel
(Contains primer pairs that target the coding regions of the tumor suppressor genes
BRCA1 and BRCA2, which have been implicated in hereditary breast and ovarian cancers, at least 30 ng per DNA sample is needed)
Bioinformatics analysis needed Yes

No

If no, what kind of raw data fails are requested?

FastQ file

BAM file

VCF file
Direct sequencing validation needed Yes

No

IV. SAMPLE REQUIREMENTS:
Tubes should be labelled with a unique ID and should be submitted with a typed sample information document.
It is recommended to use high quality non-degraded DNA (A
260
/A
280
>1,7) diluted in ddH
2
O.
Please provide the total amount of DNA supplied, the concentrations of DNA in ng/ul the method used and the analysis results measured by gel electrophoresis graph.
V. INVOICING INFORMATION
Person:_________________________________________________________________
Institute:_______________________________________________________________

Department:____________________________________________________________
Address:_______________________________________________________________
Invoice/project number:____________________________________________________
For more information required:
About the tests,
Help how to choose the right test for each separate case or type of project
To discuss the required reagents and consumables for the experiments,
To discuss budget issues, please contact
To schedule experiments in time
To discuss future project design
Terms and conditions of using the Genomics Core facilities
Please contact with:
Prof. R. Kaneva
Executive manager of MMC
email: kaneva@mmcbg.org
Daniela Dacheva,
Laboratory manager of MMC
email: dacheva@mmcbg.org
Chief Asist Prof. A. Mitkova, email: mitkova@mmcbg.org
Project manager of MMC
Genomics Core
Molecular Medicine Centre,
Medical University of Sofia
2 Zdrave St., 1431 Sofia, Bulgaria
Tel.: (+359) 2 9172 214 http://www.mmcbg.org
; mmcbg@abv.bg