Consent Forms

Client & Patient Support

Genetic Testing Informed Consent Policy
Consent: Description: Form:
ABCA4 Consent/requisition for molecular genetic testing for ABCA4 mutations ABCA4
ALS Consent/requisition for molecular genetic testing for SOD1 gene analysis for Amyotrophic Lateral Sclerosis ALS
Autopsy Consent for autopsy for the purpose of ascertaining the cause of death and furthering medical knowledge ALS
BMPR2 Consent/requisition for molecular genetic testing for BMPR2 mutations BMPR2
CFTR Consent/requisition for Cystic Fibrosis Gene: 60 Mutation Panel or CFTR (ACOG Panel) Genotyping CFTR
Clinical Genetic Testing in Non–Columbia Labs

Implementation of the new 2008 CU policy for obtaining informed consent for clinical genetic testing in CU laboratories is going well. Subsequently, several faculty have inquired about the process for clinical genetic testing at non-C.U. laboratories – commercial or academic, where outside consent forms are not necessarily compliant with NY State law.

We offer the following guidance to clinicians:
  • You can supplement the consent form used for genetic testing at non-CU laboratory(ies) by using the attached form. Copies of signed forms are to be maintained in the patient’s hospital record.
  • If you are not sure if non-C.U. consent forms are compliant with NY regulations, please forward forms to Jane Booth in Columbia’s General Counsel office for review: jeb@gc.columbia.edu or 212 854-0286.
NYPH Generic Genetic Testing Consent Form (For Non–CUMC Labs Only) 		Clinical Genetic Testing in Non– Columbia Labs
DYT1 Consent/requisition for molecular genetic testing for Early–Onset Torsion Dystonia DYT1
Fragile X Consent/requisition for molecular genetic testing for Fragile X (FMR1) CGG repeat expansion Fragile X
Glycogenoses–Biochemical Consent/requisition for biochemical genetic testing for disorders of glycogen/lipid metabolism Glycogenoses–Biochemical
Glycogenoses– DNA Consent/requisition for molecular genetic testing for (disorder/condition) disorders of glycogen/lipid metabolism Glycogenoses–DNA
Mitochondrial DIS Consent/requisition for genetic testing for (disorder/condition) Mitochondrial diseases Mitochondrial DIS
MLH1, MSH2 & MSH6 Consent/Requisition for Immunohistochemistry for Hereditary Nonpolyposis Colorectal Cancer MLH1, MSH2 & MSH6
PWS Consent/requisition for molecular genetic testing for Prader Willi/Angelman Syndrome by southern blot PWS
Release of Information Patient's release of information authorization for slides and reports PWS
SMA Consent/requisition for molecular genetic testing for SMN1 and SMN2 GENE PWS
Thrombophilia Consent/requisition for genetic testing for Factor V Leiden and Prothrombin 20210G>A Mutations Thrombophilia
 
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