Genomic Answers for Kids Nomination Form
REMINDER:
REMINDER:
*This study is not meant for and should not be used to replace clinical genetic testing that would otherwise be ordered. *It is also important that families understand that we do not have a timeframe for results. A family should never be given an estimate to the amount of time it will take to hear from us.
Patient Name
MRN
Nominating Provider
Department
Does the patient's family require a translator?
(not a required field)
If yes, what language?
(not a required field)
Provider Notes
(not a required field)
E-mail Notification?
Click the box to receive an e-mail when the patient is consented to the study
Submit
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