IPC Histology Request Form

IPC Histology Request Form

For a full list of IPC services, recommendations, and formatting, please reference these resources.

Requestor Information

Name(s) for Pick-up

Only needed if different pickup person than requestor/lab

E-mail(s) for Pick-Up*

Please separate multiple e-mails with a semicolon

Date Request Submitted*

Additional Submission Information

Please provide tracking information if being shipped

Pathology

Please only select if submitting for Experimental Pathology Program (EPP) or Pathology Services Unit (PSU).

Check here if not at OHSU

We will generate a PO for billing purposes.

PI On Funding Source*

Department*

Type in department if not found in dropdown

Select or enter value

Fiscal Authority*

Select or enter value

Request and Sample Details

Animal ID(s)*

For any human patient samples, e-mail IPC@ohsu.edu. This form is not equipped to manage PHI.

Species*

Type in species if not in drop-down list

Rhesus Macaque

Pathologist*

Select or enter value

If Other was chosen above, please describe submission

Total Number of Samples*

Please list sum of all samples being submitted or number of cassettes being requested. If submitting for any hourly charge, please put 0)

Sample Inventory*

If uploading an inventory below, please write the name of the attached file.

If collecting GI for gut rolls, please request cassettes ahead of time and indicate cassettes can be printed at time of submission.

Inventory

Cassette requests and inventory use this format (this link will not automatically open a new window)

If collecting GI for gut rolls, please request cassettes ahead of time and indicate cassettes can be printed at time of submission.

AT2 barcoded labeling requests use this format (IPC staff will fill in stain date and slide number if applicable). Please include each slide (i.e. if you have 60 slides to scan, you will have 60 rows on the submission form).

You can submit multiple files in your request. Please label file names clearly.

Drag and drop files here or

Date Cassettes Needed

Special Instructions

Please indicate here if there is anything IPC should know about before starting this request (i.e. priority of certain samples, specific dates)

Priority Level

Routine

Pre-Processing

Please Note: IPC does NOT perform any grossing aside from gut rolls.

For decalcification, investigators will be required to trim tissue to appropriate size prior to cassetting if tissue is too large.

Number of Tissues to Decal

Decalcification Reagent

Formical

Total Number of Tissues to Cassette

Include any tissues submitted in conicals for cassetting NOT including gut rolls.

If taking tissues back to cassette in lab prior to processing, do not include decalcified tissues in this total.

Total Number of Gut Rolls

If collecting GI for gut rolls, please request cassettes ahead of time and indicate cassettes can be printed at time of submission.

Processing and Embedding

Total Number of Samples for Processing*

Please include all gut rolls and tissues being cassetted by IPC in this total (not including mega cassettes).

Total Number of Super Mega Cassettes

These are commonly used for large brain pieces

Initial Fixative*

A link to our fixation recommendations can be found here. (this link will not automatically open a new window)

Duration in Fixative (time)*

Current Fixative*

We strongly recommend not leaving samples in Ethanol for longer than 5 days after fixation.

Date in Current Fixative*

This is for IPC to prioritize processing to ensure cassettes get processed within 5 days of being in ethanol. If you are unsure when tissue was placed in current fixative please put approximate date.

Processing Type*

Please Note: if larger tissues go into the 30 minute processor, they risk being under-processed.

30 Minute Processor

90 Minute Processor

Embedding Instructions

If unchecked, all tissues will be embedded "as is"

Routine ("as is" in cassette)

On Edge

Cross Section (tube structure)

Other (please e-mail IPC@ohsu.edu with further instructions)

Special Embedding Instructions (optional)

Total Number of Slides Requested*

Please check box if samples are for cryosectioning

Fixation Status*

Select or enter value

Slide Type

Leica Apex Clipped Corner is the default slide brand used in the IPC.

Please Note: If using the Leica Bond, Fisherbrand Superfrost Plus is required.

White Leica Apex Clipped Corner

Special Sectioning Instructions

Please indicate if there is any special considerations (i.e. area of interest, if slides are for specific staining platform, if tissue should be collected immediately as it appears instead of when a full representation of the tissue is visible)

Number of Slides per Block*

Standard (1 section per slide at 5um)

Sections per Slide

Please Note: multiple sections on a slide may vary depending on the size of the tissue

Section Thickness (in um)

If blank, all blocks will be sectioned at 5um

Serial

Sections in sequential order

Step

Indicate number of um between sectons

Stain Requested*

Please Note: Multiplex staining requires a consult with Rachel Dannay (dannay@ohsu.edu) prior to selection.

Section Thickness

Please include if providing pre-cut slides (even if cut by IPC previously)

Additional Staining Information

Please indicate if specific slides should be stained (i.e. H&E on slide 4 and special stain on slide 10)

Number of SHS Slides*

SHS Requested*

If the special stain you want is not listed here, please contact the IPC manager at dannay@ohsu.edu

A full list of the special stains we offer can be found here.

Select or enter value

Antibody or Probe Optimization Required?

Contact IPC before project is initiated if optimization is required

Number of Multiplex Slides*

Number of IHC Slides*

Primary Antibody Vendor

Antibody Catalog Number*

Primary Antibody Species

If different than given values, please e-mail Rachel Dannay at dannay@ohsu.edu

Select or enter value

Number of ISH Slides*

Please note that some staining kits or reagents may need to be purchased to complete request

Probe Catalog Number

Detection Options

Chromogen (Brown)

Chromogen (Red)

Fluorescence

Fluorescent Channel(s)

If selecting multiple for a multiplex, please consult with Rachel Dannay (dannay@ohsu.edu)

Select or enter value

Additional Fluorophore Information

If multiple stains were selected, please indicate what colors are needed below

Slide Scanning*

Please make sure to include an AT2 barcode label template in this format if automatically-generated file names are being requested.

AT2

VS120

Confocal

Number of Slides to Scan*

Additional Scanning Information

If number of scanned slides differs from number of sectioned slides, please indicate which slides are to be scanned (i.e. only scan H+Es, but AT2 barcode all slides including unstained).

Scanning Magnification*

Select

AT2 File Format*

Select

Send me a copy of my responses

Requestor Information

Billing Information

Request and Sample Details

Pre-Processing

Processing and Embedding

Sectioning

Staining

Scanning