Molecular Diagnostic Laboratory Requisition Form (Page 2 of 2) in pdf

Pre-test Counselling Information

Molecular Genetic Diagnostic Testing

We recommend that the following points be discussed with the patient and / or guardian(s) prior to ordering

molecular testing through the Molecular Diagnostic Laboratory at the Stollery Children's Hospital.

1. Blood or tissue samples (ex. amniotic fluid, chorionic villi) will be collected and DNA will be extracted.

After the test(s) is completed, any remaining DNA will be banked in the laboratory.

2. Current testing may not be able to detect all genetic mutations associated with the suspected condition.

The accuracy, implications and limitations of this testing should be reviewed prior to testing.

3. DNA analysis is limited to the requested test and cannot rule out all other genetic conditions or mutations.

The correct clinical diagnosis is important for accurate DNA results.

4. Improved or additional testing may become available either because of changes in laboratory techniques

or because of new information regarding the genetic cause of the condition(s). In some cases, when

improved or additional testing becomes available at the Molecular Diagnostic Laboratory at the Stollery

Children's Hospital, the patient's DNA may be re-tested. When possible, the patient and / or ordering

physician will be contacted if a mutation or clinically significant gene change is identified.

5. Confidentiality will be maintained to the best of our ability as required by the applicable health privacy laws

and the College of Physicians and Surgeons of Alberta. The results may be used anonymously to help

interpret test results for other family members. Information that DNA has been banked may be shared to

prevent needless repeat blood drawing.

6. DNA testing may reveal information about genes or gene changes other than the requested genetic test.

The significance of such a gene change may be unclear. DNA testing may also uncover non-paternity

or an undisclosed adoption. Accurate test results depend on knowing the correct relationship between

family members.

7. DNA may be given to research centres, with appropriate research ethics board approval, to help further

research. Identifying patient information will be kept confidential.

8. Participation in genetic testing is completely voluntary. The patient may withdraw consent or request that

their DNA sample be discarded at any time.

9. DNA testing may result in some forms of discrimination (insurance, employment or other).

10. Testing is based on the current level of knowledge in medical genetics. It is the patient and / or physician's

responsibility to periodically seek up-dated information especially before any reproductive decisions are

made. The patient is responsible for keeping their physician(s) informed of address changes and new

medical and family history information.

CH-0854 Apr 2008

Molecular Diagnostic Laboratory Requisition Form Page 2