PCSC Clinical Trial Request

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Required format:

xBSvNcBodZAdXYCjgyAszpp

This survey is for Clinical Trial Requests only. Please submit any request that is NOT for a Clinical Trial through: https://redcap.link/TDSC-request
Clinical Trial Requests will not be available for send out or pick up until all billing has been approved by the PI.
For all larger Clinical Trial projects, please email PathTDSC@pennmedicine.upenn.edu before completing the survey.
Please email PathTDSC@pennmedicine.upenn.edu with any questions related to the survey.

BLOCK RELEASE UPDATED POLICY - EFFECTIVE February 22, 2023:

RELEASE OF UNIVERSITY OF PENNSYLVANIA MATERIALS TO OUTSIDE INSTITUTION.pdf

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Update Status
Last Update:
Note:
Priority Action:

Is This Related To Another Project?

Yes No

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Project Number In REDCap & Title

Check any that apply to this project

Inactive projects are projects that have been placed on hold by the PI or the PQ after 3 unanswered reminders to the PI (??).

Make sure to record details regarding "inactive" status in the communication and notes fields below.

Record only

Inactive

Would you like this project to be listed on your "pending" dashboard?

Yes

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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

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Describe why project is inactive

Expand

Specialist in Charge (PQ):

Amy

Danielle

Emma

Lara

Li-Ping

Nicole

Jeffrey

Sarah

Natalie

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Would you like this project to be displayed on a co-worker's dashboard?

Yes

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Select people to view this project on their dashboard.

Amy

Emma

Jeffrey

Lara

Li-Ping

Nicole

Sarah

Natalie

Are you requesting an FFPE block from Penn for your Clinical Trial Request?

* must provide value

No, I am just requesting unstained slides, stained slides and/or punches.

Yes, my study only accepts blocks.

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In order for any Penn block to be released, you must upload consent by the patient and the study protocol where it specifies only a block will be accepted.

Was the procedure done at Penn (HUP, Pennsylvania, Presby)?

* must provide value

Yes

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Do you have the outside block in your possession?

* must provide value

Yes

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Please send the block to TDSC at 3020 Market St. after completing the remaining survey.

Please request the block now and then come back to fill out the survey when you have the block in your possession.

Please forward the email chain with approval for block release to PathTDSC@pennmedicine.upenn.edu with the person who granted approval copied and finish the survey.

All Penn blocks require special permission from the appropriate Chair of Pathology to be released. If your study can accept slides or tubes instead of blocks, the institution would prefer you request that. However, if only blocks can be accepted for the study, please email the people below for release of blocks before completing the survey. Once you obtain special permission, please complete the survey.

Select Origin of Block:

*For Help, look at what the first 1-2 letters of the accession number are.*

* must provide value

HUP: SH, HS, S, CN, NG, HA, or A

PAH: PA, SB, SP, or CG

PPMC/PMC: PP, PS, or CP

Hemepath: PH or HH

Outside Case: HC, CC, NO, OS, or CC

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Leslie.Litzky@pennmedicine.upenn.edu and Christopher.Mignogna@pennmedicine.upenn.edu

franz.fogt@pennmedicine.upenn.edu and Christopher.Mignogna@pennmedicine.upenn.edu

anna.moran@uphs.upenn.edu and Christopher.Mignogna@pennmedicine.upenn.edu

Megan.Lim@pennmedicine.upenn.edu and Christopher.Mignogna@pennmedicine.upenn.edu

Penn is not permitted to release blocks from outside institutions. Please contact the original institution to acquire the block. If the block is still in Penn's possession, please email Christopher.Mignogna@pennmedicine.upenn.edu and he can try to expedite the block's return to the original institution.

Will you accept slides or tubes instead of an entire FFPE block?

* must provide value

Yes

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Please change your answer to the first question.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.