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{"sheet":"Biospecimen Request Form 1","index":0,"n_rows":113,"n_cols":7,"rows_kept":113,"cut":false,"hidden":false,"merged":[[0,0,0,5],[16,0,16,5],[17,1,17,5],[50,0,50,5],[48,0,48,5],[49,1,49,5],[1,1,1,5],[2,1,2,5],[3,1,3,5],[14,4,14,5],[15,4,15,5],[14,1,14,2],[15,1,15,2],[10,4,10,5],[11,4,11,5],[12,4,12,5],[13,4,13,5],[7,0,7,5],[52,0,52,5],[4,1,4,5],[5,1,5,5],[6,1,6,5],[8,1,8,2],[9,1,9,2],[10,1,10,2],[11,1,11,2],[12,1,12,2],[13,1,13,2],[8,4,8,5],[9,4,9,5],[51,1,51,5],[47,1,47,5]]}
["PRBB Biospecimen Request Form"]
["Project Title:"]
["Principal Investigator Name"]
["Institution:"]
["Date:"]
["Email:"]
["Phone Number:"]
[]
["Request Date:",null,null,"U54 Related Project (Y/N):","<Click to Select>"]
["Protocol Number:",null,null,"PRBB  Co-Leaders Approval?","<Click to Select>"]
["Name of IRB",null,null,"Approval Date:"]
["IRB #",null,null,"Co-Investigator/Institution:"]
["Funding Source/Agency:",null,null,"Co-Investigator/Institution:"]
["Pay Account #:",null,null,"Co-Investigator/Institution:"]
["Date Completed",null,null,"Protocol Pathologist/Institution:"]
["Date Released",null,null,"Protocol Pathologist/Institution:"]
["Project Overview"]
["Please provide a brief project overview and high level specific aims which provide justification for requested biospecimens. If additional space is needed please include a brief, high level one page abstract describing your request. "]
["Biospecimen Selection Criteria","Example","Request #1","Request #2","Request #3","Request #4"]
["Tissue Type:","Breast"]
["Inclusion Criteria:"]
["Exclusion Criteria:",{"$nulls":5},{"$f":"SUM(B24:F24)","v":30}]
["Solid Tissue"]
["Fresh Frozen: # of cases",30]
["Fresh Frozen: weight/sample","25 mg"," "," "," "," "]
["Matched Normal","Yes",{"$nulls":4},{"$f":"SUM(B28:F28)","v":30}]
["What type of Normal Tissue is desired?","Adjacent","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["Fresh Frozen Normal Tissue: # of samples",30]
["Fresh Frozen Normal Tissue: weight/sample","25 mg"," "," "," "," "]
["FFPE:  # of Cases",30]
["FFPE:  # of Unstained Sections/Case",5,{"$nulls":4},0]
["H&E: Do you need an H&E for each tumor?","Yes","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["H&E: Do you need an H&E for each normal?","Yes","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["TMA: What is the name of the TMA block?","Colon",{"$nulls":4},0]
["TMA Sections: # of Sections",3,{"$nulls":4},0]
["TMA sections: Do you need a H&E for the TMA?","No","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>",{"$f":"SUM(B43:F43)","v":0}]
["Other Solid Tissue:","see below",{"$nulls":4},{"$f":"SUM(B44:F44)","v":30}]
["Blood Derivatives"]
["Plasma: # of Samples",10," "," "," "," "]
["Plasma: Volume/sample (ml)","0.50ml"," "," "," "," "]
["Serum: # of samples",5," "," "," "," "]
["Serum: Volume/sample","0.250ml"," "," "," "," "]
["Nucleic Acids"]
["Nucleic Acid:  # of RNA samples",30,{"$nulls":4},30]
["Nucleic Acid:  ug/sample","3 ug "," "," "," "," "]
["Nucleic Acid:  # of DNA samples",30]
["Nucleic Acid:  ug/sample","2 ug"," "," "," "," "]
["Please provide any additional nucleic acid related request information that would be useful for fullfilling your request."]
["Data Requirements"]
["Please provide a list of needed data elements and pre-analytical variable (i.e. A20/A280, RIN#, etc) to accompany sample set requested above."]
["Comments/Additional Request Instructions:",{"$nulls":5},{"$f":"SUM(G22:G45)","v":120}]
["Please provide any additional nucleic acid related request information that would be useful for fullfilling your request.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            If you have questions please call PSM-MCC PRBB @ (787) 8402575 x 2206. Requested services have to be consistent with the listed research protocol's requirements.          \n         \n"]
["Please use additional Biospecimen & Data Summary if greater than 4 tissue types are requested."]
[]
[]
[]
[]
["Solid_Vol","Liq_Vol","Tissue_Type","Honest_Broker","Type_of_Data","Normal_Tissue_Type"]
["<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["25 mg","0.250 ml","Adrenal Gland","ISS","Anonymous","Adjacent"]
["50 mg","0.500 ml","Ampulla of Vater","HRI","De-Identified","Non-Adjacent"]
["100 mg","0.750 ml","Anus/Rectum","Spoke Level","Identifiable","Other: described below"]
[">100 mg","1.00 ml","Bile ducts","Tissue Core","Yes_No","TMA Block"]
["Other:",">1.00 ml","Brain-Brain Stem","BMI","<Click to Select>"]
["NA_Vol","FFPE_Section_Thickness","Bone marrow",null,"Yes"]
["<Click to Select>","<Click to Select>","Bladder",null,"No"]
["1 ug","10 microns x 6 sections","Blood"]
["2 ug","20 microns x 3 sections","Breast"]
["3 ug ","4-5 micron section","Cecal Appendix"]
["5 ug",null,"Cervix"]
["6 ug",null,"Duodenum"]
["7 ug","Protocol_Selector1","Esophagus"]
["8 ug","<Click to Select>","Eye"]
["9 ug","TCC (MCC#14690)","Fallopian Tube"]
[">10 ug ","LCS (MCC#14553)","Fluids"]
[null,"MCC#13579","Gallbladder"]
[null,"TCC & MCC# 13579","Kidney"]
[null,"Pre-HIPAA","Larynx"]
[null,"PI Driven/Other: specify below","Large Intestine-bowel-Colon"]
[null,"No preference","Liver"]
[null,"Submission_Type","Lung"]
[]
[null,"<Click to Select>","Lymph node"]
[null,"New Submission","Mesenteric"]
[null,"Revised Submission","Meninges"]
[null,null,"Nerve-Spinal cord"]
[null,null,"Non Specified"]
[null,null,"Ovary"]
[null,null,"Pancreas"]
[null,null,"Parathyroid"]
[null,null,"Penis/scrotum"]
[null,null,"Peritoneun"]
[null,null,"Placenta"]
[null,null,"Pleura"]
[null,null,"Prostate"]
[null,null,"Renal Pelvis"]
[null,null,"Salivary Gland"]
[null,null,"Seminal vesicle"]
[null,null,"Skin"]
[null,null,"Soft tissue"]
[null,null,"Small Intestine-bowel"]
[null,null,"Spleen"]
[null,null,"Stomach"]
[null,null,"Testes"]
[null,null,"Tongue"]
[null,null,"Tonsils"]
[null,null,"Thymus"]
[null,null,"Thyroid"]
[null,null,"Urethra"]
[null,null,"Ureter"]
[null,null,"Uterus"]
[null,null,"Vagina"]
[null,null,"Vulva"]

{"sheet":"Biospecimen Request Form 2","index":1,"n_rows":113,"n_cols":7,"rows_kept":113,"cut":false,"hidden":false,"merged":[[5,1,5,5],[0,0,0,5],[1,1,1,5],[2,1,2,5],[3,1,3,5],[4,1,4,5],[6,1,6,5],[7,0,7,5],[8,1,8,2],[8,4,8,5],[9,1,9,2],[9,4,9,5],[10,1,10,2],[10,4,10,5],[11,1,11,2],[11,4,11,5],[12,1,12,2],[12,4,12,5],[13,1,13,2],[13,4,13,5],[14,1,14,2],[14,4,14,5],[15,1,15,2],[15,4,15,5],[51,1,51,5],[52,0,52,5],[16,0,16,5],[17,1,17,5],[47,1,47,5],[48,0,48,5],[49,1,49,5],[50,0,50,5]]}
["PRBB Biospecimen Request Form"]
["Project Title:"]
["Principal Investigator Name"]
["Institution:"]
["Date:"]
["Email:"]
["Phone Number:"]
[]
["Request Date:",null,null,"U54 Related Project (Y/N):","<Click to Select>"]
["Protocol Number:",null,null,"PRBB  Co-Leaders Approval?","<Click to Select>"]
["Name of IRB",null,null,"Approval Date:"]
["IRB #",null,null,"Co-Investigator/Institution:"]
["Funding Source/Agency:",null,null,"Co-Investigator/Institution:"]
["Pay Account #:",null,null,"Co-Investigator/Institution:"]
["Date Completed",null,null,"Protocol Pathologist/Institution:"]
["Date Released",null,null,"Protocol Pathologist/Institution:"]
["Project Overview"]
["Please provide a brief project overview and high level specific aims which provide justification for requested biospecimens. If additional space is needed please include a brief, high level one page abstract describing your request. "]
["Biospecimen Selection Criteria","Example","Request #5","Request #6","Request #7","Request #8"]
["Tissue Type:","Breast"]
["Inclusion Criteria:"]
["Exclusion Criteria:",{"$nulls":5},{"$f":"SUM(B24:F24)","v":30}]
["Solid Tissue"]
["Fresh Frozen: # of cases",30]
["Fresh Frozen: weight/sample","25 mg"," "," "," "," "]
["Matched Normal","Yes",{"$nulls":4},{"$f":"SUM(B28:F28)","v":30}]
["What type of Normal Tissue is desired?","Adjacent","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["Fresh Frozen Normal Tissue: # of samples",30]
["Fresh Frozen Normal Tissue: weight/sample","25 mg"," "," "," "," "]
["FFPE:  # of Cases",30]
["FFPE:  # of Unstained Sections/Case",5,{"$nulls":4},0]
["H&E: Do you need an H&E for each tumor?","Yes","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["H&E: Do you need an H&E for each normal?","Yes","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["TMA: What is the name of the TMA block?","Colon",{"$nulls":4},0]
["TMA Sections: # of Sections",3,{"$nulls":4},0]
["TMA sections: Do you need a H&E for the TMA?","No","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>",{"$f":"SUM(B43:F43)","v":0}]
["Other Solid Tissue:","see below",{"$nulls":4},{"$f":"SUM(B44:F44)","v":30}]
["Blood Derivatives"]
["Plasma: # of Samples",10," "," "," "," "]
["Plasma: Volume/sample (ml)","0.50ml"," "," "," "," "]
["Serum: # of samples",5," "," "," "," "]
["Serum: Volume/sample","0.250ml"," "," "," "," "]
["Nucleic Acids"]
["Nucleic Acid:  # of RNA samples",30,{"$nulls":4},30]
["Nucleic Acid:  ug/sample","3 ug "," "," "," "," "]
["Nucleic Acid:  # of DNA samples",30]
["Nucleic Acid:  ug/sample","2 ug"," "," "," "," "]
["Please provide any additional nucleic acid related request information that would be useful for fullfilling your request."]
["Data Requirements"]
["Please provide a list of needed data elements and pre-analytical variable (i.e. A20/A280, RIN#, etc) to accompany sample set requested above."]
["Comments/Additional Request Instructions:",{"$nulls":5},{"$f":"SUM(G22:G45)","v":120}]
["Please provide any additional nucleic acid related request information that would be useful for fullfilling your request.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            If you have questions please call PSM-MCC PRBB @ (787) 8402575 x 2206. Requested services have to be consistent with the listed research protocol's requirements.          \n         \n"]
["Please use additional Biospecimen & Data Summary if greater than 4 tissue types are requested."]
[]
[]
[]
[]
["Solid_Vol","Liq_Vol","Tissue_Type","Honest_Broker","Type_of_Data","Normal_Tissue_Type"]
["<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>","<Click to Select>"]
["25 mg","0.250 ml","Adrenal Gland","ISS","Anonymous","Adjacent"]
["50 mg","0.500 ml","Ampulla of Vater","HRI","De-Identified","Non-Adjacent"]
["100 mg","0.750 ml","Anus/Rectum","Spoke Level","Identifiable","Other: described below"]
[">100 mg","1.00 ml","Bile ducts","Tissue Core","Yes_No","TMA Block"]
["Other:",">1.00 ml","Brain-Brain Stem","BMI","<Click to Select>"]
["NA_Vol","FFPE_Section_Thickness","Bone marrow",null,"Yes"]
["<Click to Select>","<Click to Select>","Bladder",null,"No"]
["1 ug","10 microns x 6 sections","Blood"]
["2 ug","20 microns x 3 sections","Breast"]
["3 ug ","4-5 micron section","Cecal Appendix"]
["5 ug",null,"Cervix"]
["6 ug",null,"Duodenum"]
["7 ug","Protocol_Selector1","Esophagus"]
["8 ug","<Click to Select>","Eye"]
["9 ug","TCC (MCC#14690)","Fallopian Tube"]
[">10 ug ","LCS (MCC#14553)","Fluids"]
[null,"MCC#13579","Gallbladder"]
[null,"TCC & MCC# 13579","Kidney"]
[null,"Pre-HIPAA","Larynx"]
[null,"PI Driven/Other: specify below","Large Intestine-bowel-Colon"]
[null,"No preference","Liver"]
[null,"Submission_Type","Lung"]
[]
[null,"<Click to Select>","Lymph node"]
[null,"New Submission","Mesenteric"]
[null,"Revised Submission","Meninges"]
[null,null,"Nerve-Spinal cord"]
[null,null,"Non Specified"]
[null,null,"Ovary"]
[null,null,"Pancreas"]
[null,null,"Parathyroid"]
[null,null,"Penis/scrotum"]
[null,null,"Peritoneun"]
[null,null,"Placenta"]
[null,null,"Pleura"]
[null,null,"Prostate"]
[null,null,"Renal Pelvis"]
[null,null,"Salivary Gland"]
[null,null,"Seminal vesicle"]
[null,null,"Skin"]
[null,null,"Soft tissue"]
[null,null,"Small Intestine-bowel"]
[null,null,"Spleen"]
[null,null,"Stomach"]
[null,null,"Testes"]
[null,null,"Tongue"]
[null,null,"Tonsils"]
[null,null,"Thymus"]
[null,null,"Thyroid"]
[null,null,"Urethra"]
[null,null,"Ureter"]
[null,null,"Uterus"]
[null,null,"Vagina"]
[null,null,"Vulva"]