Welcome to the Family Portal for donating to the NIGMS Repository!
Quick Links:
--Required Paperwork to Return with Kit
--Additional Useful Forms
--Formularios, en Español
--Disease-Specific Clinical Forms
| Document | Description |
| Submission Form | Form that must be submitted for each donor and describes donor's basic information |
| Informed Consent Form | Consent form that must be read completely and signed by each donor |
| Assent Form | Consent form that must be signed by a donor that is between the ages of 7-17 and able to do so. This must be accompanied by the Informed Consent Form. |
| Clinical Data Elements Form (General) | Form that should be submitted for affected individuals only and details this individual's clinical symptoms |
| Document | Description |
| Kit Contents | Provides a complete list of items found in both pediatric and adult blood and biopsy kits |
|
Blood Kit Instructions |
Provides detailed instructions for collecting, packaging and shipping blood donations from within the United States |
| Blood Kit Instructions (International) | Provides detailed instructions for collecting, packaging, and shipping blood donations internationally |
| 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 |
| Back-to-Submitter Rights |
Form to assign Back-to-Submitter rights to a researcher to receive a single cell line or DNA sample free-of-charge (excluding iPSCs) |
| Informed Consent for the Transfer of Existing Specimens |
Consent form that should be read completely and signed by a donor of a sample that has already been collected and is to be transferred to the NIGMS Repository (e.g. established cell line) |
| Formulario | Descripción |
| Formulario de Consentimiento Informado | Formulario de consentimiento que debe ser leído y firmado por cada donante |
| Formulario de Asentimiento | Formulario que debe utilizarse junto con el documento de consentimiento informado por donante jóven entre 7 y 17 años de edad, y con la capaz de hacerlo |
| Formulario De Envío | 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 |
| Formulario de Elementos de Datos Clínicos (Por Anomalías Cromosómicas) | Formulario que debe enviarse solo para individuos afectados por anomalías cromosómicas y detalla los síntomas clínicos de este individuo |
| Documento de Consentimiento Informado para la Transferencia de Muestras Existentes | Formulario de consentimiento que debe ser leído y firmado por donante de una muestra ya collectada (incluye línea celular) |
| Instrucciones para el Envío de Biopsias de Tejido | Contenido del kit de Coriell para el envío de biopsias de tejido, y instrucciones detalladas del procedimiento. |
The following forms should only be submitted for individuals affected by the respective disorder
| Document | Description |
| Clinical Data Elements Form (Chromosomal Abnormalities) | For individuals affected by a chromosomal abnormality only and details this individual's clinical symptoms |
| Clinical Data Elements Form (Congenital Muscular Dystrophy CMD) | For individuals affected by congenital muscular dystrophy only and details this individual's clinical symptoms |
| Clinical Data Elements Form (Rett Syndrome; MECP2) | For individuals affected by Rett syndrome only and details this individual's clinical symptoms |
| Clinical Data Elements Form (Smith-Magenis Syndrome) | For individuals affected by Smith-Magenis syndrome only and details this individual's clinical symptoms |
| Clinical Data Elements Form (Propionic Acidemia) | For individuals affected by propionic acidemia only and details this individual's clinical symptoms |
| Clinical Data Elements Form (Pitt-Hopkins Syndrome) | For individuals affected by Pitt-Hopkins syndrome only and details this individual's clinical symptoms |
If you have any questions that are not answered in this Family Portal, please email us at NIGMS@coriell.org
