If you are an EXTERNAL healthcare provider with no access to Nationwide Children’s Epic system, submission of a completed Test Requisition Form is required. Please use:

• Genetic Test Requisition Form for a postnatally obtained tissue (e.g. skin biopsy, muscle biopsy, surgically obtained tissue, autopsy tissue from a liveborn patients)
• POC Test Requisition Form for tissue obtained from pregnancy loss / products of conception (POC). For any fetal sample greater than or equal to 20 weeks 0 day gestation, completion of DISPOSITION OF REMAINS section of the requisition form is required. 

If you are an INTERNAL ordering provider with access to Nationwide Children’s Epic system, no requisition form is required for skin biopsy collections; please place the lab order electronically in Epic. In the "Comments" section, please enter the tissue source of sample (e.g., skin, muscle, etc.). For a skin biopsy performed on the main Nationwide Children's Campus (700 Children's Drive), Cytogenetics lab can supply a skin biopsy kit -- please call at least 24 hours in advance to request. For a POC sample, do NOT place an Epic order - complete the NCH Internal Genetics POC Fetal Tissue Requisition.

Collected tissue sample should be placed in a sterile container containing tissue transport media or sterile saline, and tissue should be completely immersed in the media/saline. DO NOT freeze or expose to formalin or other fixatives. Transport the specimen to the laboratory as soon as possible at room temperature. Sample may be refrigerated if specimen must be stored overnight.

* If sufficient tissue sample is submitted (greater than 10mm cube of tissue), then a portion of the sample will be frozen and stored in the laborartory, which can be used for additional DNA-based testing in future if tissue culture fails (e.g., microarray analysis). Long-standing fetal demise, delayed specimen transport, and improper handling can increase the risk of tissue culture failure, which leads to no chromosome result.

This test evaluates chromosomes in 20 cultured cells from tissue sample. This test is used to evaluate for numerical and structural chromosomal abnormalities in tissue specimen, such as the presence/absence of aneuploidies, chromosome translocations, and chromosome inversions. Turnaround time for results varies depending on the rate of cell growth in culture. If evaluation of extra cells (beyond the routine 20 cells) is desired to evaluate for a low-level mosaicism for a chromosome abnormality, please request "Mosaicism Study" on the lab order and additional cells (up to 50 cells) will be evaluated at extra charge (CPT code 88263).

• If patient has a family history of known chromosome abnormality, please provide the family member's chromosome result information (attach a copy of test result if available). If the proband was tested at Nationwide Children's Hospital Cytogenetics Laboratory, please provide the proband name, date of birth, and accession number (if available).
• If cryopreservation of cultured cells and/or additional in-house or send-out testing on cultured cells is desired, please clearly indicate this on the lab order. Otherwise, cultured cells will be discarded 2 weeks after the tissue chromosome analysis result is issued.
• If cryopreservation of cultured cells is ordered, a portion of cultured cells will be frozen and stored for possible future testing. Cyropreservation charge will apply (CPT code 88240).
• If additional testing on cultured cells is also ordered (e.g. adding on microarray analysis, send out cultured cells to another laboratory, etc.), please call Cytogenetics Lab to speak with a laboratory genetic counselor to coordinate. For molecular genetic testing to be performed on cultured cells from the products of conception (POC), submission of maternal sample (4 mL blood in EDTA tube) is also recommended to perform maternal cell contamination study.
• For sending out cultured cells to another reference laboratory or to perform DNA isolation on cultured cells, additional culture charge will be billed (under additional CPT code 88233).
• If Tissue Culture Only (no chromosome analysis) is desired, please see test code: TCULT.

Common indications for this testing include:

• Evaluating for presence of mosaicism for chromosomal abnormality in patients who previously had normal blood chromosome analysis but clinically demonstrates signs of chromosomal abnormality.
• Evaluating chromosomes in patients who had allogenic bone marrow transplant since these patients' blood sample represent bone marow donor sample rather than the patient's germline sample.
• Evaluating for chromosome abnormality in products of conception tissues obtained from spontaneous or therapeutic abortions to investigate possible cause of pregnancy loss or fetal abnormalities.
• Evaluating for chromosome abnoramality in autopsy samples where patients demonstrate multiple congenital abnormalities or other signs of chromosome abnormality.

If you are an EXTERNAL healthcare provider with no access to Nationwide Children’s Epic system, submission of a completed Test Requisition Form is required. Please use:

• Genetic Test Requisition Form for a postnatally obtained tissue (e.g. skin biopsy, muscle biopsy, surgically obtained tissue, autopsy tissue from a liveborn patients)
• POC Test Requisition Form for tissue obtained from pregnancy loss / products of conception (POC). For any fetal sample greater than or equal to 20 weeks 0 day gestation, completion of DISPOSITION OF REMAINS section of the requisition form is required. 

If you are an INTERNAL ordering provider with access to Nationwide Children’s Epic system, no requisition form is required for skin biopsy collections; please place the lab order electronically in Epic. In the "Comments" section, please enter the tissue source of sample (e.g., skin, muscle, etc.). For a skin biopsy performed on the main Nationwide Children's Campus (700 Children's Drive), Cytogenetics lab can supply a skin biopsy kit -- please call at least 24 hours in advance to request. For a POC sample, do NOT place an Epic order - complete the NCH Internal Genetics POC Fetal Tissue Requisition.

Collected tissue sample should be placed in a sterile container containing tissue transport media or sterile saline, and tissue should be completely immersed in the media/saline. DO NOT freeze or expose to formalin or other fixatives. Transport the specimen to the laboratory as soon as possible at room temperature. Sample may be refrigerated if specimen must be stored overnight.

* If sufficient tissue sample is submitted (greater than 10mm cube of tissue), then a portion of the sample will be frozen and stored in the laborartory, which can be used for additional DNA-based testing in future if tissue culture fails (e.g., microarray analysis). Long-standing fetal demise, delayed specimen transport, and improper handling can increase the risk of tissue culture failure, which leads to no chromosome result.

This test evaluates chromosomes in 20 cultured cells from tissue sample. This test is used to evaluate for numerical and structural chromosomal abnormalities in tissue specimen, such as the presence/absence of aneuploidies, chromosome translocations, and chromosome inversions. Turnaround time for results varies depending on the rate of cell growth in culture. If evaluation of extra cells (beyond the routine 20 cells) is desired to evaluate for a low-level mosaicism for a chromosome abnormality, please request "Mosaicism Study" on the lab order and additional cells (up to 50 cells) will be evaluated at extra charge (CPT code 88263).

• If patient has a family history of known chromosome abnormality, please provide the family member's chromosome result information (attach a copy of test result if available). If the proband was tested at Nationwide Children's Hospital Cytogenetics Laboratory, please provide the proband name, date of birth, and accession number (if available).
• If cryopreservation of cultured cells and/or additional in-house or send-out testing on cultured cells is desired, please clearly indicate this on the lab order. Otherwise, cultured cells will be discarded 2 weeks after the tissue chromosome analysis result is issued.
• If cryopreservation of cultured cells is ordered, a portion of cultured cells will be frozen and stored for possible future testing. Cyropreservation charge will apply (CPT code 88240).
• If additional testing on cultured cells is also ordered (e.g. adding on microarray analysis, send out cultured cells to another laboratory, etc.), please call Cytogenetics Lab to speak with a laboratory genetic counselor to coordinate. For molecular genetic testing to be performed on cultured cells from the products of conception (POC), submission of maternal sample (4 mL blood in EDTA tube) is also recommended to perform maternal cell contamination study.
• For sending out cultured cells to another reference laboratory or to perform DNA isolation on cultured cells, additional culture charge will be billed (under additional CPT code 88233).
• If Tissue Culture Only (no chromosome analysis) is desired, please see test code: TCULT.

Common indications for this testing include:

• Evaluating for presence of mosaicism for chromosomal abnormality in patients who previously had normal blood chromosome analysis but clinically demonstrates signs of chromosomal abnormality.
• Evaluating chromosomes in patients who had allogenic bone marrow transplant since these patients' blood sample represent bone marow donor sample rather than the patient's germline sample.
• Evaluating for chromosome abnormality in products of conception tissues obtained from spontaneous or therapeutic abortions to investigate possible cause of pregnancy loss or fetal abnormalities.
• Evaluating for chromosome abnoramality in autopsy samples where patients demonstrate multiple congenital abnormalities or other signs of chromosome abnormality.

This test evaluates chromosomes in 20 cultured cells from tissue sample. This test is used to evaluate for numerical and structural chromosomal abnormalities in tissue specimen, such as the presence/absence of aneuploidies, chromosome translocations, and chromosome inversions. Turnaround time for results varies depending on the rate of cell growth in culture. If evaluation of extra cells (beyond the routine 20 cells) is desired to evaluate for a low-level mosaicism for a chromosome abnormality, please request "Mosaicism Study" on the lab order and additional cells (up to 50 cells) will be evaluated at extra charge (CPT code 88263).

• If patient has a family history of known chromosome abnormality, please provide the family member's chromosome result information (attach a copy of test result if available). If the proband was tested at Nationwide Children's Hospital Cytogenetics Laboratory, please provide the proband name, date of birth, and accession number (if available).
• If cryopreservation of cultured cells and/or additional in-house or send-out testing on cultured cells is desired, please clearly indicate this on the lab order. Otherwise, cultured cells will be discarded 2 weeks after the tissue chromosome analysis result is issued.
• If cryopreservation of cultured cells is ordered, a portion of cultured cells will be frozen and stored for possible future testing. Cyropreservation charge will apply (CPT code 88240).
• If additional testing on cultured cells is also ordered (e.g. adding on microarray analysis, send out cultured cells to another laboratory, etc.), please call Cytogenetics Lab to speak with a laboratory genetic counselor to coordinate. For molecular genetic testing to be performed on cultured cells from the products of conception (POC), submission of maternal sample (4 mL blood in EDTA tube) is also recommended to perform maternal cell contamination study.
• For sending out cultured cells to another reference laboratory or to perform DNA isolation on cultured cells, additional culture charge will be billed (under additional CPT code 88233).
• If Tissue Culture Only (no chromosome analysis) is desired, please see test code: TCULT.

Common indications for this testing include:

• Evaluating for presence of mosaicism for chromosomal abnormality in patients who previously had normal blood chromosome analysis but clinically demonstrates signs of chromosomal abnormality.
• Evaluating chromosomes in patients who had allogenic bone marrow transplant since these patients' blood sample represent bone marow donor sample rather than the patient's germline sample.
• Evaluating for chromosome abnormality in products of conception tissues obtained from spontaneous or therapeutic abortions to investigate possible cause of pregnancy loss or fetal abnormalities.
• Evaluating for chromosome abnoramality in autopsy samples where patients demonstrate multiple congenital abnormalities or other signs of chromosome abnormality.

If you are an EXTERNAL healthcare provider with no access to Nationwide Children’s Epic system, submission of a completed Test Requisition Form is required. Please use:

• Genetic Test Requisition Form for a postnatally obtained tissue (e.g. skin biopsy, muscle biopsy, surgically obtained tissue, autopsy tissue from a liveborn patients)
• POC Test Requisition Form for tissue obtained from pregnancy loss / products of conception (POC). For any fetal sample greater than or equal to 20 weeks 0 day gestation, completion of DISPOSITION OF REMAINS section of the requisition form is required. 

If you are an INTERNAL ordering provider with access to Nationwide Children’s Epic system, no requisition form is required for skin biopsy collections; please place the lab order electronically in Epic. In the "Comments" section, please enter the tissue source of sample (e.g., skin, muscle, etc.). For a skin biopsy performed on the main Nationwide Children's Campus (700 Children's Drive), Cytogenetics lab can supply a skin biopsy kit -- please call at least 24 hours in advance to request. For a POC sample, do NOT place an Epic order - complete the NCH Internal Genetics POC Fetal Tissue Requisition.

Collected tissue sample should be placed in a sterile container containing tissue transport media or sterile saline, and tissue should be completely immersed in the media/saline. DO NOT freeze or expose to formalin or other fixatives. Transport the specimen to the laboratory as soon as possible at room temperature. Sample may be refrigerated if specimen must be stored overnight.

* If sufficient tissue sample is submitted (greater than 10mm cube of tissue), then a portion of the sample will be frozen and stored in the laborartory, which can be used for additional DNA-based testing in future if tissue culture fails (e.g., microarray analysis). Long-standing fetal demise, delayed specimen transport, and improper handling can increase the risk of tissue culture failure, which leads to no chromosome result.

This test evaluates chromosomes in 20 cultured cells from tissue sample. This test is used to evaluate for numerical and structural chromosomal abnormalities in tissue specimen, such as the presence/absence of aneuploidies, chromosome translocations, and chromosome inversions. Turnaround time for results varies depending on the rate of cell growth in culture. If evaluation of extra cells (beyond the routine 20 cells) is desired to evaluate for a low-level mosaicism for a chromosome abnormality, please request "Mosaicism Study" on the lab order and additional cells (up to 50 cells) will be evaluated at extra charge (CPT code 88263).

• If patient has a family history of known chromosome abnormality, please provide the family member's chromosome result information (attach a copy of test result if available). If the proband was tested at Nationwide Children's Hospital Cytogenetics Laboratory, please provide the proband name, date of birth, and accession number (if available).
• If cryopreservation of cultured cells and/or additional in-house or send-out testing on cultured cells is desired, please clearly indicate this on the lab order. Otherwise, cultured cells will be discarded 2 weeks after the tissue chromosome analysis result is issued.
• If cryopreservation of cultured cells is ordered, a portion of cultured cells will be frozen and stored for possible future testing. Cyropreservation charge will apply (CPT code 88240).
• If additional testing on cultured cells is also ordered (e.g. adding on microarray analysis, send out cultured cells to another laboratory, etc.), please call Cytogenetics Lab to speak with a laboratory genetic counselor to coordinate. For molecular genetic testing to be performed on cultured cells from the products of conception (POC), submission of maternal sample (4 mL blood in EDTA tube) is also recommended to perform maternal cell contamination study.
• For sending out cultured cells to another reference laboratory or to perform DNA isolation on cultured cells, additional culture charge will be billed (under additional CPT code 88233).
• If Tissue Culture Only (no chromosome analysis) is desired, please see test code: TCULT.

Common indications for this testing include:

• Evaluating for presence of mosaicism for chromosomal abnormality in patients who previously had normal blood chromosome analysis but clinically demonstrates signs of chromosomal abnormality.
• Evaluating chromosomes in patients who had allogenic bone marrow transplant since these patients' blood sample represent bone marow donor sample rather than the patient's germline sample.
• Evaluating for chromosome abnormality in products of conception tissues obtained from spontaneous or therapeutic abortions to investigate possible cause of pregnancy loss or fetal abnormalities.
• Evaluating for chromosome abnoramality in autopsy samples where patients demonstrate multiple congenital abnormalities or other signs of chromosome abnormality.