Note
Due to European legislation, all typed information of your patient will be erased when placing the order.
A secured email with the patients information will be sent to Amsterdam UMC Genome Diagnostics.
Patient information
Declaration on another person
Information Ordering Physician
Test
Indication
Sample material details
Nb. if CNV analysis in an NGS package is desired, only send freshly collected EDTA (anticoagulated) blood.
Blood
For adults 2x 6-7 ml, small children 5-10 ml / (never freeze, do not use 4 ml tubes).
Clearly indicate name, date of birth and gender on all blood tubes.
Umbilical cord blood
5-10 ml / (never freeze, do not use 4 ml tubes).
Clearly indicate name, date of birth and gender on the blood tubes. Also send mother’s blood.
DNA
NGS panels 10μg, other tests 5μg.
DNA isolated from
Also send mother’s blood.
Saliva
Only when collected in Oragene OG-500 kits.
Buccal swabs
Biopt / Tissue
Volume 0.5 cm3. Note: muscle facie, NO muscle tissue
Fibroblasts
Chorion villi
Amnion
Other sample material
Indicate this in the pedigree on the printed order form.
Clinical information
Confirmation of clinical diagnosis
Confirmation of clinical suspicion
Carrier detection (recessive disease)
Pre symptomatic test
Prenatal testing
Genotyping for desired prenatal testing
Interpretation of previously found variant
NB: Declaration on the index; Fill in data index at “Has material from family member(s) been sent previously to Amsterdam UMC?”
Other
Clinical information additional to obesity
Clinical information additional to connective tissue disorders
Clinical information additional to EpiSign tests
Clinical information additional to neurogenetics
Clinical information additional to preconception panel
Notes
Consent