Page 437 - CHST Research Administration eBook 2 of 2 (Q4 2021)

Study PI LAST NAME Study Short Name/Title
_________________,_______________________________________
Sample Test Type & Visit/Dosing
Velos # _*_**_**_____________
Note: To ensure adherence to the study protocol, this completed instruction sheet MUST accompany the specimen/s.
Subject Study ID: ___________________________
Patient MRN: _______________
Accession #: _____D-_______R____________
Lab Study Approval #: ________________________
RA******-***
❖ NURSING/PHLEBOTOMY INSTRUCTIONS:
1. Enter a Spin & Hold Study OR Spin & Hold Study Complex order in the computer using; IRB #: STU- ****-**
Match the order requisition or care fusion label with sample.
2. Specimen Collection - Collect n/a of blood into a Blue Top Tube
Label the tube following standard hospital operating procedures for specimen collection. Write collection date, time, and hospital login
initials on the label. Document Collection Date & Time: ______________________________________ Note here if samples need to be inverted or placed in an ice bath.
3. Label the transport tubes with the preprinted study labels.
4. Place sample, labeled transport tubes, and this instruction sheet in a specimen bag and send to lab.
*place order label here if available*
❖ LABORATORY INSTRUCTIONS:
1.
2. 3.
PROCESS SAMPLE – No Processing Required N/A N/A N/A
You may type additional notes here (ex. double spin. how many aliquots, how much in each, etc.)
SAMPLE LABEL - Ensure CMC patient identifier is removed from tube and prelabeled with Subject Study ID. SAMPLE STORAGE/SHIPMENT –
You may type additional notes here, as needed.
Questions?
CONTACT: Research Processing Lab Staff, at EXT 6-2612
RC Name(s) , Research Coordinator(s), at RC Contact # (cell preferred) PI First & Last Name , Study PI, at PI Contact # (cell preferred)
Same Day Ship - Frozen
to Covance
❖ PROCESSING, STORAGE & SHIPMENT INFORMATION:
To ensure adherence to the study protocol, please fill in each blank below.
1. Time Centrifuged: __________ Temperature of Centrifuge: __________
2. Time of storage: ___________ Storage Location (Please circle one): -70/-80 -20/-30 Fridge Ambient/RT
3. Freezer or Refrigerator used (Please write the probe/asset tag number here): _________________
4. Lab Tech Initials: _________________
5. Date moved to 2nd floor research lab: _________________ 6. Date shipped: ________________________
8-19
*The typed information entered above is accurate and based on the most current IRB-approved protocol/manual. Any future modifications or amendments to this study will be submitted to the lab for review and approval before those changes can be implemented. The lab is not responsible for the accuracy of the instructions on this sheet.