INVEST Pharmacogenetics Substudy
Genetic
samples
Please
complete this form and return it with the patient samples.
Site: __________
Name
and phone # of contact person:
________________________________________________________________________
Range
of dates the samples were collected (starting from and ending): _____________________
Storage
conditions: Room temperature
_____ Refrigerated _____
Number
of samples in shipment: __________ Date of shipment: ______________
Patient ID and Initials |
Collection
date
|
Usable
sample
For lab use only |
Patient ID and Initials
|
Collection date |
Usable
sample
For lab use only |
|
Example: 102 TMA |
Example: |
Example:
No/sample leaked |
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Instructions
for shipping:
Please
return samples in the original box the supplies were shipped in within 3 weeks
of collecting the sample. Additional
shipping containers will be sent to you when the lab receives the sample
shipment. Fasten caps securely and pack
to minimize movement during shipping.
Use the enclosed shipping label to send via 2-day express mail. Complete
the return shipping label with the date and a contact name (the return shipping
has been prepaid). Please notify the lab
of shipping via email at kathy@cop.ufl.edu.
Do not ship on Fridays, Saturdays, or the day before a holiday.
Ship
to:
Dr. Julie Johnson
Department of Pharmacy
Practice (352) 392-3155 |
For lab use only: Date received: ____________________ Container ID: ____________________ Usable samples:
___________________
Staff initials: _____________________ |