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  • Universal Clinical Sample Request Form

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    Ulisses
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    This document is a universal clinical sample request form containing fields for the date, requester name, reasons for request, receipt dates, patient ID/MRN numbers, types of samples requested including CSF, serum, plasma, PBMCs, urine, saliva, PaxGene and tissue. For each sample type, it includes fields for the number of vials and location. The bottom of the form provides instructions for searching the STAMS database to locate requested samples.

    Original Description:

    A quick way to documents samples you need to grab out of a freezer.

    Original Title

    Sample Usage Form

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    This document is a universal clinical sample request form containing fields for the date, requester name, reasons for request, receipt dates, patient ID/MRN numbers, types of samples requested including CSF, serum, plasma, PBMCs, urine, saliva, PaxGene and tissue. For each sample type, it includes fields for the number of vials and location. The bottom of the form provides instructions for searching the STAMS database to locate requested samples.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    21 views1 page

    Universal Clinical Sample Request Form

    Uploaded by

    Ulisses
    This document is a universal clinical sample request form containing fields for the date, requester name, reasons for request, receipt dates, patient ID/MRN numbers, types of samples requested including CSF, serum, plasma, PBMCs, urine, saliva, PaxGene and tissue. For each sample type, it includes fields for the number of vials and location. The bottom of the form provides instructions for searching the STAMS database to locate requested samples.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Universal Clinical Sample Request Form

    Date: _______________
    Your Name: _________________________
    Reasons: ____________________________________________________________________
    ____________________________________________________________________

    Receipt Date: _________________ Protocol: _______________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Receipt Date: _________________ Protocol: ________________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Receipt Date: _________________ Protocol: ________________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Receipt Date: _________________ Protocol: ________________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Receipt Date: _________________ Protocol: ________________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Receipt Date: _________________ Protocol: ________________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Receipt Date: _________________ Protocol: ________________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Receipt Date: _________________ Protocol: ________________


    ID/MRN CSF Serum Plasma PBMC Urine Saliva PaxGene Tissue
    # of vial
    Location

    Searching STAMS: Use “Search and Export” on the sidebar. Click on the “+” to create a search

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