What service are you requesting in support of this Project/Study?
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Sample Collection, Processing and Storage in Support of a Research Study, Grant, Clinical Trial, etc.
Retrospective Data or Samples
Is this request for one of the following studies or an access protocol to one of the following studies?
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Yes No
Has the Surgery Data Management (SDM) Intake Survey been completed for this request?
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Yes No
Please use the link below to complete the Surgery Data Management Intake Survey for Data/Sample Pulls. The Program Manager will notify you once you have approval to return to the SSCRS survey to complete it.
https://redcap.duke.edu/redcap/surveys/?s=8TYMJ474X3
Please upload email documentation of Surgery Data Management's approval to proceed with Sample Request from SSCRS.
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Last Name of Person Making This Request
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Contact person
First Name of Person Making This Request
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Contact person
Email Address of Person Making This Request
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Contact person
Role of Person Making This Request
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PI
Study Coordinator
Laboratory Personnel
Research Fellow
Principle Investigator Last Name
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Principle Investigator First Name
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Principle Investigator's Email Address
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Name of Study
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Ab Wall - STY-18-00048 ACTIV2 - Adapt Out COVID - STY-20-00176 ACTIVE 3 - COVID-19 - STY-20-00100 Acupuncture - STY-20-00018 AFT-42 - STY-20-00006 Allergan - STY-17-00129 Alliance - STY-17-00106 Alzheimer's Disease Center Clinical Core & Repository - STY-20-00165 ATR - STY-16-00013 BACCI - STY-17-00098 Bariatric Surgery - STY-17-00041 BRS - STY-18-00043 C3PO - STY-20-00189 CTOT20 - STY-16-00006 CTOT22 - STY-17-00107 CTPM - STY-17-00016 D2C7 - STY-16-00111 D2C7 + Atezo - STY-20-00007 DC27-IT antiCD40 - STY-21-00056 DCI Breast Cancer - STY-19-00025 DHHR - STY-16-00018 DHHR - STY-17-00096 Dicerna FAILM - STY-20-00188 DTRT/AIM2 - STY-16-00113 DTRT2 - STY-16-00017 Embark - STY-16-00079 ENACT - STY-16-00112 FKD - STY-17-00118 FREEDOM-1 - STY-20-00180 GLI - STY-16-00070 Hand Bela - STY-16-00007 Healthy Control - STY-16-00003 Heterotopic Pig Heart TXP - STY-19-00063 HFN-HIV - STY-16-00115 HOPE 1000 - STY-18-00088 HSR Repository - STY-20-00013 Immune Design - STY-16-00077 Immuron - STY-16-00011 IMVigor 1 - STY-16-00080 IMVigor 2 - STY-17-00130 Intuvax - STY-17-00122 Key Largo - STY-17-00127 LDR - STY-17-00006 Lomustine / ISTARI - STY-17-00051 LTOG - STY-17-00008 MADRA - STY-20-00168 MitoGel - STY-17-00121 Moderna - STY-18-00018 Momentum - STY-17-00126 Mouse VCA - STY-18-00075 MT-202 COVID-19 - STY-20-00167 NHP - STY-19-00033 Pfizer - STY-18-00091 PICK-NEPC - STY-17-00125 PIP - STY-16-00120 Planet - STY-17-00085 PNC - STY-17-00097 Polio - STY-16-00110 Polio-Peds - STY-17-00128 Proceed - STY-17-00110 PRONOUNCE - STY-20-00022 Propranolol Trial - STY-20-00169 Quark - STY-16-00016 REHAB-HF - STY-17-00119 Regeneron - STY-20-000164 Rose - STY-17-00120 Sarcoma - STY-17-00123 SBR - 1000PT - STY-16-00096 SBR - MWLs - STY-16-00096_MWLs SC2i - STY-16-00001 SGE Sage - STY-17-00042 Taris - STY-18-00090 TBI - STY-18-00089 Teach - STY-18-00060 Tempo - STY-18-00098 TOP 1901 - STY-20-00060 TOP-1501 - STY-17-00013 TOP-1502 - STY-16-00109 TOP-1705 - STY-18-00086 Vaginal Mesh Stud - STY-16-00097 VCAci - STY-16-00002 VCAci PreClinical - STY-17-00089 Viela Bio - STY-19-00064 WounDx - STY-16-00121 Other
Name of Study
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STY-16-00001 - SC2i STY-16-00002 - VCAci STY-16-00003 - Healthy Adult Volunteers STY-16-00007 - Hand Bela STY-16-00013 - ATR STY-16-00018 - DHHR STY-16-00070 - GLI STY-16-00079 - Embark STY-16-00096 - SBR STY-16-00096 - 1000 Patient Initiative STY-16-00096 - MWL STY-16-00111 - D2C7 STY-16-00120 - PIP STY-17-00006 - LDR STY-17-00013 - TOP-1501 STY-17-00016 - CTPM STY-17-00106 - Alliance STY-17-00110 - Proceed STY-17-00123 - Sarcoma STY-17-00127 - Key Largo STY-17-00128 - PEDS-PVSRIPO STY-18-00043 - BRS STY-18-00048 - Ab Wall STY-18-00060 - Teach STY-18-00086 - TOP-1705 STY-18-00088 - HOPE 1000 STY-18-00089 - TBI STY-18-00098 - Tempo STY-19-00025 - DCI Breast Cancer STY-19-00063 - Heterotopic Pig Heart TXP STY-19-00064 - Viela Bio STY-20-00007 - D2C7 + Atezo STY-20-00013 - HSR Repository STY-20-00018 - Acupuncture STY-20-00060 - TOP 1901 STY-20-00100 - ACTIVE 3 - COVID-19 STY-20-00164 - Regeneron COV-2067 STY-20-00165 - Alzheimer's STY-20-00168 - MADRA STY-20-00176 - ACTIV2 STY-20-00180 - FREEDOM-1 STY-20-00181 - CTOT-24 STY-20-00183 - HNCRN_LUN19-427 STY-20-00184 - PAIR-MSI STY-20-00185 - IPI/Nivo STY-20-00208 - ACTIV-1 STY-20-00234 - ACTIV-4A STY-21-00012 - Lighthouse STY-21-00027 - QED PROOF 302 STY-21-00029 - Allena ALLN-177-302 STY-21-00045 - ARIES STY-21-00047 - ACTIV-4C STY-21-00051 - ACTIV-3B TESICO STY-21-00056 - D2C7-IT antiCD40 STY-21-00081 - CARMAT STY-21-00086 - AlloVir BK STY-21-00088 - AFT-50 STY-21-00103 - Ophirex STY-21-00104 - Dicerna STY-21-00119 - Allergan - Gelinique STY-21-00127 - DOTS STY-21-00128 - Hepatocellular Carinoma STY-21-00130 - VATICO STY-21-00145 - Odyssey STY-21-00146 - BAY-ATR STY-21-00147 - ITN089ST-Adapt STY-22-00005 - TSOG Mesothelioma Pleural Effusions STY-22-00026 - Deverra STY-22-00027 - SunRISe 2 STY-22-00028 - MEM-288 STY-22-00029 - TOP-2101 STY-22-00032 - LIME STY-22-00041 - Propel STY-22-00049 - BRE18-360 STY-22-00071 - U54 Scent STY-22-00072 - BOND-003 STY-22-00073 - SGN22E-004 STY-22-00074 - FSGS STY-22-00075 - PTC-AADC-GT-002 STY-22-00080 - ACGC STY-22-00094 - Insight 017 EPOC STY-22-00101 - DREAM STY-22-00102 - OPAL STY-22-00103 - IMBARC STY-22-00104 - X-PACT STY-22-00111 - HAI FUDR STY-22-00129 - PROVE STY-23-00014 - STRIVE STY-23-00015 - Enzyvant STY-23-00016 - PN0C022 STY-23-00024 - GI-U54 Scent STY-23-00039 - Kangaroo STY-23-00040 - Newly Diagnosed D2C7/AntiCD40 STY-23-00050 - Specimen Repository & Database for Healthy Adult Volunteers STY-23-00051 - CIT-CPB-003-02 STY-23-00052 - Ex Vivo Modifications of Donor Hearts STY-23-00053 - OPHERIX - BRAVIO II STY-23-00054 - BNT152+153 STY-23-00073 - HCRN LUN21-497 STY-23-00082 - STRIVE II STY-23-00083 - TBCR047 STY-23-00103 - DIG STY-23-00111 - ITN ADAPT Cohort 2 STY-23-00112 - BESTOW STY-23-00113 - HA Chemotherapy STY-24-00028 - ABCs STY-24-00029 - CTOT-45 STY-24-00030 - CTOT-41 STY-24-00044 - Reamer Comparison STY-24-00045 - PNOC029 STY-24-00046 - Equity & Trauma STY-24-00071 - SOC-006: GO44479 STY-24-00072 - BRP-001: BRPC Study Support STY-24-00088 - CTS-018: BiVacor STY-24-00100 - URO-025: SURGE STY-24-00103 - NSG-003: Diet2Treat STY-24-00104 - URO-026: DROPLET STY-24-00105 - URO-027: Prokarium STY-24-00106 - PAC-009: CTOT-47 To Be Determined Other
Please Provide Study Name
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Are you and/or the study PI affiliated with Duke University?
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Yes No
Project Title
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How is this study funded?
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Federal (NIH, DoD, etc.) Commercial/Industry Pharmaceutical sponsored Clinical Trial Department/Division/Faculty/PI
This study will reside in the Department of:
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Anesthesiology Community & Family Medicine Dermatology Emergency Medicine Medicine Neurology Neurosurgery Obstetrics & Gynecology Ophthalmology Orthopaedic Surgery Pathology Pediatrics Psychiatry and Behavioral Sciences Radiation Oncology Radiology Surgery Urology Other
This study will reside in the Division of:
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Is your request for Human Samples/Data or Non-Human Samples/Data?
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Human Samples/Data Non-Human Samples/Data
The IRB for this study:
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Has been approved
Is pending approval
IRB Protocol Number
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Please upload your IRB approval letter.
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Please Provide IRB Number Pending Approval (If Applicable)
Study Type
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Biobanking (Adult studies that fall under broad collection and banking) Investigator Driven (Studies that require a separate, approved IRB to be provided by the investigator) Clinical Trial (Studies that require a separate, approved IRB and clinical trial protocol)
Will the sponsor be providing any supplies?
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Yes No
Please specify other supplies sponsor will be providing.
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Will an external specimen tracking system be utilized by the sponsor?
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Yes No
Will SSCRS need to ship samples or act as an honest broker for external or internal collaborators?
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Yes No
Total numbers of subjects anticipated for this study is:
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What is the duration of subject enrollment?
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1 year
2 years
3 years
4 years
5 years
How many sample collection time points are included in this study?
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Number of Time Points
Please List Your Time Points
Samples will be collected for processing by SSCRS from subjects enrolled at:
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Duke Only
Duke and Outside Sites
Outside Sites Only
How many outside sites will submit samples for processing?
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Site #1
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Site #2
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Site # 3
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Site # 4
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Site # 5
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Site # 6
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Site # 7
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Site # 8
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Site # 9
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Site # 10
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Please describe how the Whole Blood samples are to be processed.
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Do you have a document that describes a method of how you would like to have the Whole Blood samples processed?
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Yes No
Please Upload
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Where would you like for the samples to be sent to?
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Substrate Services Molecular Unit
Other
Please specify where you would like sample to be sent to.
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Please describe how the Urine samples are to be processed.
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Do you have a document that describes a method of how you would like to have the Urine samples processed?
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Yes No
Please Upload
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Please describe how the Fresh Tissue samples are to be processed.
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Do you have a document that describes a method of how you would like the Fresh Tissue samples processed?
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Yes No
Please Upload
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Please describe how the Cerebrospinal Fluid samples are to be processed.
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Do you have a document that describes a method how you would like the Cerebrospinal Fluid samples processed?
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Yes No
Please Upload
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Please describe how the Mircobiome samples are to be processed.
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Do you have a document that describes a method how you would like the Microbiome samples processed?
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Yes No
Please Upload
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Please describe how the Ascites samples are to be processed.
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Do you have a document that describes a method how you would like the Ascites samples processed?
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Yes No
Please Upload
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Please describe how the Effluent samples are to be processed.
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Do you have a document that describes a method how you would like the Effluent samples processed?
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Yes No
Please Upload
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Please describe how the Lavage samples are to be processed.
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Do you have a document that describes a method how you would like the Lavage samples processed?
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Yes No
Please Upload
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Please specify other samples to be processed by SSCRS.
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Do you have a document that describes a method on how you would like to have other samples processed?
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Yes No
Please Upload
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Please specify how other samples are to be processed by SSCRS.
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Do you have a complete study protocol and laboratory manual?
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Yes No
Please Upload Supporting Documents Here
Please Upload Supporting Documents Here
Please Upload Supporting Documents Here
Please Upload Supporting Documents Here
Please Upload Supporting Documents Here
SSCRS is looking forward to supporting your study. A draft budget will be developed based upon the information that you have provided. Once the draft budget is provided, please review and send back any comments or required revisions. This is an iterative process and we will work together ensure that we capture your study needs. Once the budget has been finalized, the next steps to study implementation/support are:
Please type your name to confirm understanding of the required steps.
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Which of these statements best suits your request?
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I am requesting samples that are stored in SSCRS that were collected under a protocol that I am listed as the PI or Key Personnel.
I am requesting samples that are stored in SSCRS that were collected under a protocol that I am NOT listed as the PI or Key Personnel.
Name of the study for which you are listed as the PI or Key Personnel and samples have been collected.
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What type of request is this regarding your samples?
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Inventory Request
Samples to be Pulled
You are requesting samples to be pulled. Please select how the samples are to be handled.
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Samples are to be picked by the requestor/requestor's team.
Samples are to be shipped to an external location.
Please Provide Shipping Information**SSCRS does NOT arrange shipments nor provides shipping containers or air-bills. Please be prepared to provide shipping supplies and air-bills at the time of notification that the sample pull has been completed.**
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Do you have documents to upload regarding shipping locations or labels?
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Yes No
Please Upload
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Please Provide Fund Code
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Is your request for Human Samples / Data or Non-Human Samples / Data?
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Human Samples / Data Non-Human Samples / Data
What is the IRB # for protocol under which the requested samples were collected?
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Do you have an access IRB protocol to use these samples?
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Yes No
Please upload your IRB approval letter.
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IRB # of the study for which you are listed as the PI or Key Personnel and samples that have been collected.
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What is the tissue type of interest?
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Please Specify Other
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Please Specify Other Sample Type at Interest
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What volume/concentration/# of sections are required for each sample type?
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Do you have a document detailing the numbers of samples you would like pulled, the collection time points of interests and any other information necessary for sample collection?
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Yes No
Please Upload
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Please provide the number of samples that you would like pulled, the collection time points of interest and any other information necessary for sample selection below.
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Please allow 7 to 10 business days for your request to be completed. Large requests may require additional time.
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Type Name Here
Do you have a document providing a description of the study population at interest?
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Yes No
I.E. Disease process, age range, gender, etc.
Please upload the document providing a brief description of the study population of interest.
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Please provide a brief description of the study population of interest. Include information such as disease process, age range, gender, etc.
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Does this study require samples from one collection time point or is this a longitudinal study?
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One time point Longitudinal
How many time points?
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How many samples are required for this study?
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Number of Subjects x Time points
Will RNA later affect the downstream assays proposed for this study?
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Yes No Unknown
Please allow 7 to 10 business days for your request to be completed. Large requests may require additional time.
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What is your affiliation?
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< big> Company Name, Institution Name, etc. < /big>
Please upload your study protocol.
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Total number of samples to be processed.
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Please specify other samples to be processed by SSCRS.
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Please type your name to confirm understanding of the required steps.
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Submit
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