Sample submission form
Accompanies every shipment. One line per tube.
Sender / institution
Contact person
Email
Phone
Shipment date
Courier and tracking number
Shipping condition: ☐ Ambient ☐ Cold pack ☐ Dry ice
| # | Sample ID / barcode | Patient ID | Sample type | Collection date | Volume / conc. | Test | Family role |
|---|---|---|---|---|---|---|---|
| 1 | |||||||
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| 4 | |||||||
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| 10 | |||||||
| 11 | |||||||
| 12 |
Checklist
- ☐ Each tube carries two identifiers that match this form.
- ☐ Test requisition enclosed for every patient.
- ☐ Signed consent on file at the sending institution.
- ☐ Tubes sealed and packed to the applicable transport rules for biological substances.
Laboratory use only
Received (date / time)
Received by
Condition on arrival
Discrepancies
© Tribro-Omics · Sample submission form · Version 1.0 · 11 November 2026