M.A.N.G.A.N.E.S.E. STUDY

GBM Clinical Validation Patient Data Registration

Date of Laboratory Processing *

Processed by

Patient ID Number *

Number Of Stained Slides Registered *

Stained Accession Slide 1 # *

Stained Accession Slide 2 # *

Stained Accession Slide 3 # *

Stained Accession Slide 4 # *

Number Of Unstained Slides Registered *

Unstained Accession Slide 1 # *

Unstained Accession Slide 2 # *

Unstained Accession Slide 3 # *

Unstained Accession Slide 4 # *

Mn Score *

Cu Score *

Zn Score *

Fe Score *

Radnost Score mg/g *

File Upload *

Please upload labeled histopathology images, labeled heat map images including Mn,Cu,Zn,Fe, and PDF Copy of Patient Histopathology Report

Drop your files here

*

Send me a copy of my responses