Mitochondrial Diseases Consent Form
Form Template
The Mitochondrial Diseases Consent Form mobile app includes an informed consent and requisition for laboratory testing.
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Informed consent MUST be signed by patient, parent/legal guardian or legal next of kin. The app requests the following tests: Mitochondrial DNA Point Mutations, Southern Blot for multiple deletions of mitochondrial DNA, Mitochondrial DNA depletion, Gene Sequencing, Mitochondrial Enzyme Analysis, Thymidine Phosphorylase activity and Coenzyme Q10 level. You can specify the content that goes within generated e-mails to the specified email addresses.
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