Website: cgs.hku.hk Contact Persons: Allen Chu / Carlos Choi Contact No: 2831-5467 / 2831-5477 Email: [email protected] Fax No.: 2818-5653 Sample Order No.: AA- ________________________________ Affy miRNA GeneChip Service Request Form User Information P.I. Name: User Name: User Email: P.I. Email: User Contact No.: Fax: Department: Billing Account: Project Name/ID: Sample Submission Date (yyyy-mm-dd): Signature: Billing Address: Service Type of Service: miRNA 4.0 Other: Qty: Qty: Type of GeneChip: Full service (Labeling, hybridization, wash, stain and scan) Hybridization, wash, stain and scan (For non-standard labeling protocol) Other: Sample Information Type of Sample: Mouse Human Rat Other: Total RNA mRNA Culture cells, line: Tissue, type: Sample Storage: RT -20°C -80°C 4°C Biohazard Samples: Yes No Note: - Please select options as appropriate. - For further information, please refer to our website: “cgs.hku.hk”. - We DO NOT accept any sample with potential biohazard. - For Research Use Only. Not for use in diagnostic procedures. - For personal data protection, please be reminded that the submitted sample IDs should NOT carry any personal information such as the HKID or passport numbers, the laboratory numbers of patient reports, or the patient IDs of hospitals. - Please refer to the Privacy and Personal Data Protection Policies at http://cgs.hku.hk/portal/index.php/policies for information on personal data protection and handling by CGS. RNA quality requirements: 1. Concentration > 130ng/ul 2. A260/280 = 1.7 - 2.1 3. Consistent 28s / 18s ratio 4. RIN >= 8.0 Sample ID Bioanalyzer Order No. 28S/18S RIN Remarks 1 2 3 4 5 6 7 8 9 10 11 12 Is this a follow-up experiment? Yes No Sign Date Remarks Sample received by Order receive GeneChip received from Affy Coating wells Labeling and QC Hybridization Data QC (1) and upload Data review by GS and QC (2) For Official Use Wash, Stain and Scan Sample Tracking Data quality approval Data delivery to user Remarks: Sign Date Remarks FS Module FS Module 1 7 2 8 3 9 4 10 5 11 6 12 Invoice GeneChip lot: DB Order, Sample info Sample Process Labeling kit Lot: Hybrid protocol: Labeling protocol: QC Payment (For Official Use) Item Unit Price Qty Sub total (HK$) AA $ $ AA $ $ Total: $ Job done by: Date: QA/QC Supervisor: Date: v20181126