Billing mechanisms must be in place BEFORE requesting laboratory services. Set up an OnCORE account so your grant will be billed instead of the patient. Fill out the OnCORE and submit by email or fax to:
Phone: (203) 688-9003
Fax: (203) 688-3330
To obtain clinical laboratory tests or services for human research studies, submit:
Request for Human Subjects Research Form
The HIC number and HIC approval letter must be provided.
If excess clinical samples are requested, submit an additional form:
Excess Clinical Samples (HIPAA) Form.
An HIC signature is required if the samples will have identifiers or codes of any kind.
to submit the individual. Enter the Account number prominently at the top left.
For pre-aliquoted samples brought to the lab for batch testing, contact the individual laboratory for details.
To obtain clinical laboratory tests for non-human research studies, obtain a OnCore as above and submit the Request for Non-Human Research Form.Primate samples are not accepted.
To aid in preparation of budgets, a pricing estimate can be requested using the Request for Pricing Only Form. This estimate is based on handling and testing that is identical to a routine clinical sample. Any deviation from the routine will incur additional charges.
Forms described in B or C above must be submitted and approved before sample submission and testing can begin. Prices are valid for the current fiscal year only.
Obtain a OnCore account, PTAEO number, and HIC approval, and submit Request for Phlebotomy Only Form to firstname.lastname@example.org. Arrangements for specimen pickup and drawstation location must be made in advance. The phlebotomists will not centrifuge, deliver or mail specimens.
Billing will be done quarterly at a minimum. If the PTAEO changes, it is the responsibility of the researcher to notify email@example.com in advance of the change.
Phlebotomy service for research studies is not guaranteed, but will depend on both study requirements and laboratory resources.