A-Gathering Information B-Block & Slide retrieval & organization C-Block & Slide Initial review D-AOI selection E-1st Adequacy review (PQ) F-Alternate Selection, re-review G-Additional adequacy review (PQ and TMA tech) H-Final map design and approval I-Construction J-TMA Sectioning
Current Status/Next Step:
Bill Block Missing Clean molds Close Out - Bill & Return material Completed Confirmation of Shipment Receipt Consent Cutting Needed DNA Extraction Needed Email the IHC Director Embedding Needed Get blocks from clinical lab HE/Special Staining Needed IF Needed IHC Needed Inactive Macrodissection Needed No longer Needed Order blocks/slides Other Pathologist Circling Processing Needed Punch Needed Response about blocks Return Material Scanning Needed Send Out Send S/O or P/U Email Set up cutting station Ship Out Slides Drying TDSC Technical Director (AFZ) TASK COMPLETE Waiting for Reagent Waiting on Coordinator/PI Waiting on Fund Creation Waiting on P/U Waiting on PennKey Creation Waiting on S/O or P/U Response Waiting on sponsor Waiting on Stella Approval Waiting on TDSC Pathologist Director Waiting on TDSC Technical Director (AFZ) Waiting on Warehouse
Approve Consent Make Decision Respond to Email Chain
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Task Assigned Task Finished with no issues Task Finished, see notes No Current Assignment
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ASAP End of Day End of Week End of Month
Bill Create Redcap Project Create Stella Quote Embed Inventory Make Block Cassettes Order material Other Package Slides Print Slides Return Material Coverslip (specify approx. time) Update Redcap (specify instruments) Set up water bath Clean molds
Remember to "Finish Task" above.
Is This Related To Another Project?
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Project Number In REdCap & Title
Check any that apply to this project
Would you like this project to be listed on your "pending" dashboard?
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No
Reason project is inactive
PI decided not to move forward
Project is on hold waiting for funding
Project is on hold until trial starts
No response from PI
Other
Describe why project is inactive
Specialist in Charge (PQ):
Alexandra
Amanda
Amy
Danielle
Emma
Lara
Li-Ping
Nicole
Jeffrey
Sarah
Natalie
Lauren
Specialist in Charge (PQ):
Alexandra
Amanda
Amy
Danielle
Emma
Lara
Li-Ping
Nicole
Jeffrey
Sarah
Natalie
Lauren
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No
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Select Service needed
* must provide value
New project consultation
Research requests
Research/Bio-marker Study Recuts
Clinical support services
TTAB/CHTN processing requests
PCD billing (PCD Staff Only)
Block Request for Research to Penn Core
Research Request
For RESEARCH SCANNING, re-select service "Clinical support services" above then "Scanning."
For a NEW Research Project, please click "New project consultation" above. For a continual project, please email your normal contact at TDSC. Thank You!
Starting a NEW project?
Yes
No
TTAB
CHTN
Scanning
Recuts for Education
IHC for interest
New antibody workup for clinical use
What Type Of Project Is This?
* must provide value
Clinical Support
Research
Clinical Trial
QC/Trouble-shooting (Test Development ONLY)
Control Block
Other
Case/block review and selection
Control block usage
Pennmed diagnostic
TTAB, CHTN
PI provided
Other
Accession # and block ID(s)
Block ID for non Pennmed cases
Year of collection (for TTAB blocks)
How will this block be used?
General control Project-specific Control
Research
Clinical
Tumor
Diseased
Benign
Other
Antibody/probe specific? Ex: HPV+, mutation positive, etc
Yes
No
In the Project Title field below, copy the following information:______ ______ : ______ ______ , ______ ; ______
Admin Clinical conference Consult CPD Education/training/meetings/workshop For interest Legal New test development QC/Performance testing Multiple (see specific instrument) Other
Reason for new test develpment
New test
Discontinuation
Sub-optimal performance
Improvements (workflow, class, cost, etc)
Backorder
IMPORTANT INFORMATION:
Block releases are infrequent and occur only as a last resort. If your studies can be performed on cut sections, block requests will be denied. All requests will be reviewed by Lab Director. Every block request must be accompanied by a patient consent to exhaust. Please upload a PDF or .zip file containing all consent form(s). Additionally, indicate the estimated return date of the blocks. If the blocks are lost or not returned within 3 months, future block releases to the PI group and/or collaborators will be at risk.
Â
Consent form(s): Â
Block Need By Date:
Rush Request? Â Â
Block Destination:
Block Return Date: Â
Testing to be performed on block:
Upload block release consent forms
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Yes No
Testing to be performed on block?
Requestor Information
Name:
Project Information
Principal Investigator:
Project Title:
IRB #:
Name of new antibody to be clinically validated:
Clinical validation requires at least 10 positive and 10 negative cases. The participation of the requesting pathologist will be crucial to facilitate the process. Please provide the following information as much as you can.
1. Will this staining result be used to guide therapy (e.g. HER2, PD-L1)?
Yes
No
Tests for predicting and selecting therapy are not considered ASR1 tests and are subject to FDA regulation (501K premarket approval) and require at least 20 positive and 20 negative cases.
2. Clinical purpose (i.e. differential diagnosis #1 vs #2 vs etc.)
Include 2 or more references. Copy link here (PMID) or use Upload button below to upload pdf.
3. Company and antibody name (IVD preparations are preferred). If you don't know we can search (write "No Preference"):
4. Anticipated number of cases to be tested per year:
< 20
20-100
>100
5. Accession and block numbers for positive and negative control tissues for antibody titration:
6. Please provide a list of at least 20 blocks for validation: 10 blocks each for positive and negative.
Last name, First name
PI to bill if different from Project PI
Collaborating Pathologist:
Pathologist/Fellow/Resident
Use abbreviation
Collaborators (if applicable)
Enter collaborators to be copied on email and Stella
Yes
No
If yes, this project must be completed before the abstract deadline.
Materials and Methods sent?
Yes
No
N/A
Today M-D-Y
Is the project any of the following:
EEF
CHTN
TTAB
Natalie Shih
MDF/Phillips
Was the request for new workup made by someone other than the IHC Director or Associate Director?
Yes
No
Was application for new workup submitted?
Yes No
Request for New Antibody Workup
Please upload request form
Is request approved by IHC Director or Assoc Director?
Yes
No
Would you like this project to be listed on your "pending" dashboard?
Yes
No
Ex: By PJZ on 1-1-11 by email
Project Communication- Copy emails here with date and who entered the email
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
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Do you have another patient?
Yes
No
You may continue adding patients in the fields below OR use the "Upload" buttons to upload a spreadsheet or word document containing patient name, DOB, Accession number.
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
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Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
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Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Â
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Do you have another patient?
Yes
No
Patient Information
Name:
Date of Birth:
Pathology Accession # and Block ID:Â
Example:Â SH22-059123 A2
Today M-D-Y
Enter Accession number(s) and instructions in the "Instructions" field below.
Enter block ID and stain needed in the "Instructions" field below.
Upload tissue submission form using the "Upload" field below.
need instructions & specimen fields
Show me the Instructions field.
I have a document to upload. I don't need the Instructions field.
Project Overview / Request Instructions
Instructions/Specimen ID's
Block Request Information:
IDs of Blocks Requested: Â
Number of Blocks Requested:
Â
If there is only 1 block per case, it may be release only if the patient is deceased, molecular studies have been done, or patient consent is obtained. Â
Is there any case where there is only 1 block in the case? If so, please list and note what condition of the above applies per case:
Number of blocks requested:
more than one block per request?
Yes No
Enter instructions in the "Instructions" field below and include the following:
Number of slides or rolls
Routine
Rush
Need by date:
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Need by date:
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Please check any additional requirements:
Reminder: When sending a pathology report via email, you must put "Encrypt" in the email subject line and include the following statement in the footer of the email: "The information contained in this e-mail and its attachment are confidential, privileged, or otherwise protected from disclosure. It is intended only for the use of the authorized individual and/or entity named above."
Yes
No
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View equation
Additional fee will apply
Project INSTRUCTIONS: Enter client's instructions along with date including all additions, changes, etc.
Ex: 8-15-17 PAL added 3 cases
Project NOTES--Do not enter instructions here. Use this space for additional relevant information along with date.
Ex: 8-15-17 reminded XYZ that we need cases this week to make their deadline
Is there more paperwork to upload?
Yes
No
Your request will be forwarded to the Director for approval.
Do Reagents Need To Be Ordered?
Yes
No
Today M-D-Y
Ex: Chris Mignogna
Details of reagent request
Quantity, Vendor, Catalog #
Backorder, follow-up, etc
Has The Order Been Received?
Yes
No
Today M-D-Y
3020 Market St. Lab
6 Founders
PAH Pathology
PPMC Pathology
Other
All blocks must be returned within 30 business days.
Yes
No
Level 1 (1-10 slides/specimens)
Level 2 (11-20 slides/specimens)
Level 3 (>20 slides/specimens)
Rate
AP-funded projects Resident Research funded projects Ap Startup funds for new faculty Consult and Discretionary funds for AP faculty Reagent cost only projects approved by Dr. Feldman
Intra-department (AP Fund)
Internal (UPENN grants)
Mixed (AP and Internal)
External Academic
External Commercial
TTAB
CHTN
Type of Intra-departmental project
Resident Research
AP-funded project
AP faculty startup funds
Consult or discretionary funds for AP faculty
Special Reagent cost only project (No Labor cost), AP startups, etc.
Reagent cost only - labor cost supported by another PI
Other
Upon approval, AP Funds should be created in the PBR AP Fund Tracker. You will need to enter:
PI (Pathologist Mentor) Title of project Maximum spending limit Date of approval Redcap number (can be added later)
Project entered into Redcap AP fund tracker?
Yes
No
Fund entered into PBR AP-fund tracker?
Yes
No
Title of AP-funded project in fund tracker
Proposal saved to "AP funded projects" in "Projects" shared folder?
Yes
No
Please enter date and method of Dr. Feldman's approval to use AP rate for non-AP project.
Who is providing salary support?
Ex: G-Robert Vonderheide - Colon RO1
Select services needed for this project
Number of specimens to be processed.
Please fill out this form, upload it below and include with your specimens.
Upload Completed Processing Request Form here.
Processing & Embedding Instructions 1
Yes No
Processing & Embedding Instructions 2
Yes No
Processing & Embedding Instructions 3
Yes No
Processing & Embedding Instructions 4
Yes No
Processing & Embedding Instructions 5
Yes No
Processing & Embedding Instructions 6
Yes No
Processing & Embedding Instructions 7
Yes No
Processing & Embedding Instructions 8
Yes No
Processing & Embedding Instructions 9
Yes No
Processing & Embedding Instructions 10
View standard thickness for different assays?
Yes
No
Standard Thickness:
Yes
No
Will instructions for sectioning onto SLIDES apply to all specimens?
Yes
No
If instructions do not apply to all specimens, please upload detailed instructions in the upload field below.
Thickness of sections (in microns)
Number of slides to cut for each block
Charged
Uncharged
Specimen ID. Please list specimens to be cut onto slides.
do you need any of the following
Slide brand and details (catalog number or name)
Slides are labeled with specimen ID unless noted here. We can create de-identifiers for you. If needed, please request PCSC de-identifiers.
Number of sections to place on each slide
Are all sections from the same block?
Yes
No
We will be in touch for details regarding section placement
Please upload section placement instructions here.
Will instructions for sectioning ROLLS apply to all specimens?
Yes
No
If instructions do not apply to all specimens, please upload detailed instructions in the upload field below.
Thickness of sections (in microns)
Number of sections per tube.
Number of tubes per specimen.
Additional sectioning notes.
Cutting instructions 1
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 2
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 3
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 4
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 5
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 6
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 7
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 8
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 9
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 10
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 11
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 12
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 13
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 14
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 15
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 16
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 17
Yes
No
Use molecular cutting protocol?
Yes
No
Yes No
Cutting instructions 18
Yes
No
Use molecular cutting protocol?
Yes
No
H&E or Special stain Instructions 1
Special stains may require special cutting
Yes No
H&E or SS Instructions 2
Yes No
H&E or SS Instructions 3
Yes No
H&E or SS Instructions 4
Yes No
H&E or SS Instructions 5
Yes No
H&E or SS Instructions 6
Yes No
H&E or SS Instructions 7
Yes No
H&E or SS Instructions 8
Yes No
H&E or SS Instructions 9
Yes No
H&E or SS Instructions 10
Antibody Optimization Instructions
IHC Instructions 1
Yes No
Ihc instructions 2
Yes No
Ihc instructions 3
Yes No
Ihc instructions 4
Yes No
Ihc instructions 5
Yes No
Ihc instructions 6
Yes No
Ihc instructions 7
Yes No
Ihc instructions 8
Yes No
Ihc instructions 9
Yes No
Ihc instructions 10
ISH, RNAscope Instructions 1
Yes
No
ISH, RNAscope Instructions 2
Yes
No
ISH, RNAscope Instructions 3
Yes
No
ISH, RNAscope Instructions 4
Yes
No
ISH, RNAscope Instructions 5
Yes
No
ISH, RNAscope Instructions 6
Yes
No
ISH, RNAscope Instructions 7
Yes
No
ISH, RNAscope Instructions 8
Yes
No
ISH, RNAscope Instructions 9
Yes
No
ISH, RNAscope Instructions 10
RNA/DNA extraction and quantification instructions 1
Yes
No
RNA/DNA extraction and quantification instructions 2
Yes
No
RNA/DNA extraction and quantification instructions 3
Yes
No
RNA/DNA extraction and quantification instructions 4
Yes
No
RNA/DNA extraction and quantification instructions 5
Yes
No
RNA/DNA extraction and quantification instructions 6
Yes
No
RNA/DNA extraction and quantification instructions 7
Yes
No
RNA/DNA extraction and quantification instructions 8
Yes
No
RNA/DNA extraction and quantification instructions 9
Yes
No
RNA/DNA extraction and quantification instructions 10
Macrodissection ONLY instructions 1
Yes
No
Macrodissection ONLY instructions 2
Yes
No
Macrodissection ONLY instructions 3
Yes
No
Macrodissection ONLY instructions 4
Yes
No
Macrodissection ONLY instructions 5
Yes
No
Macrodissection ONLY instructions 6
Yes
No
Macrodissection ONLY instructions 7
Yes
No
Macrodissection ONLY instructions 8
Yes
No
Macrodissection ONLY instructions 9
Yes
No
Macrodissection ONLY instructions 10
Other assay instructions 1
Yes
No
Other assay instructions 2
Yes
No
Other assay instructions 3
Yes
No
Other assay instructions 4
Yes
No
Other assay instructions 5
Yes
No
Other assay instructions 6
Yes
No
Other assay instructions 7
Yes
No
Other assay instructions 8
Yes
No
Other assay instructions 9
Yes
No
Other assay instructions 10
Research
Conference
Teaching
Legal
Other
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Save images to (select all that apply):
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Other instructions for image files
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De-Identify?
Yes
No
Yes
No
Tech time may be charged for ink removal.
Add to: ______ ______ ______ on ______ ______ || ______ ______ || Rush: ______ ______ ______ slides @ ______ ______ || Remove Ink: ______ ______ ______ ______ ______
Drop Off Instructions:
Drop Off Instructions:
Please click the "Submit" button to complete your request. ______
Yes No
20x
40x
Save to Project # and name:
De-Identify?
Yes
No
Yes
No
Yes No
20x
40x
Save to Project # and name:
De-Identify?
Yes
No
Yes
No
Yes No
20x
40x
Save to Project # and name:
De-Identify?
Yes
No
Yes
No
Yes No
20x
40x
Save to Project # and name:
De-Identify?
Yes
No
Yes
No
Yes No
20x
40x
Save to Project # and name:
De-Identify?
Yes
No
Yes
No
Yes
No
Proscia Repository to save to:
Please specifiy where slides were saved:
Slide ID's:
Â
Number of slides to be scanned:
If from clinical lab, just type accession once.
Number of slides given for scanning:
Yes
No
Proscia Repository to save to:
Please specifiy where slides were saved:
Slide ID's:
Â
Number of slides to be scanned:
If from clinical lab, just type accession once.
Number of slides given for scanning:
Yes
No
Proscia Repository to save to:
Please specifiy where slides were saved:
Slide ID's:
Â
Number of slides to be scanned:
If from clinical lab, just type accession once.
Number of slides given for scanning:
Yes
No
Proscia Repository to save to:
Please specifiy where slides were saved:
Slide ID's:
Â
Number of slides to be scanned:
If from clinical lab, just type accession once.
Number of slides given for scanning:
Project Info Entered Date
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Project Billing info/notes
Remove from pending dashboard?
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Project Status- Is all work done and billing entered?
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No
Inactive
Please select one of the following in the Form Status Dropdown below:
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