Request a Donation Kit

Email  us at NIGMS@Coriell.org to request a kit!

Kit Information:

- Decide how many individuals will be donating a sample

  • The affected individual and all related family members are eligible to donate

- Decide what type of sample each individual would like to donate

  • This can be whole blood, skin biopsy tissue, or both

Helpful Links (English):

Kit Paperwork Description
Kit Contents Provides the full list of items found in both pediatric and adult blood and biopsy kits
Blood Kit Instructions Provides detailed instructions for packaging and shipping blood donations
Biopsy Kit Instructions Provides detailed instructions for packaging and shipping biopsy donations, in addition to providing the clinician with instructions on how to perform a skin biopsy
Informed Consent Form Consent form that must be completely read and signed by each donor
Assent Form Form that must be signed ONLY if the donor is between the ages of 7-17 and intellectually capable
Submission Form Form that must be submitted for each donor and describes donor's basic information
Clinical Data Elements Form (General) Form that should be submitted for affected individuals only and details this individual's clinical symptoms

Disease-Specific Clinical Forms:

Kit Paperwork Description
Clinical Data Elements Form (Chromosomal Abnormalities) Form that should be submitted for individuals affected by a chromosomal abnormality only and details this individual's clinical symptoms
Clinical Data Elements Form (Congenital Muscular Dystrophy CMD) Form that should be submitted for individuals affected by congenital muscular dystrophy only and details this individual's clinical symptoms
Clinical Data Elements Form (Rett Syndrome; MECP2) Form that should be submitted for individuals affected by Rett syndrome only and details this individual's clinical symptoms
Clinical Data Elements Form (Smith-Magenis Syndrome) Form that should be submitted for individuals affected by Smith-Magenis syndrome only and details this individual's clinical symptoms
Clinical Data Elements Form (Propionic Acidemia) Form that should be submitted for individuals affected by propionic acidemia only and details this individual's clinical symptoms
Clinical Data Elements Form (Pitt-Hopkins Syndrome) Form that should be submitted for individuals affected by Pitt-Hopkins syndrome only and details this individual's clinical symptoms

Enlaces Útiles (Español):

Documentos

Descripción

Formulario de Consentimiento Informado Formulario de consentimiento que debe ser leído y firmado por cada donante
Formato de Solicitud Formulario que debe presentarse para cada donante y describe la información básica del donante

Formulario de Elementos de Datos Clínicos (General)

Formulario que debe enviarse solo para individuos afectados y detalla los síntomas clínicos de este individuo