Home » chILD-EU Register » Forms for referral/support

I want patient referral/support

1) Consent to medical opinion / care by Munich center

When referring patient's data or materials for diagnosis or treatment advice to our center, we need consent of the patient/family.  A patient who agreed to participate in the chILD-EU register (see below) and consented to his/her local physician may additionally consent to Munich center access to those data. For this we need written consent: Einverständnis Mitbehandlung / consent to extension of treating team.

2) Blood tests

For genetic and serum diagnostics please use the following PDF Icon form. You may benefit from our program in genetic testing; for more information ask here.

3) Reference pathology

Nur in Deutschland für klinische Fälle vor Eintrag ins Register:

Zur Qualitätssicherung für eine optimale Referenzpathologie führen die mit chILD-EU assoziierten spezialisierten Pathologen Beurteilungen nur durch, wenn die notwendigen Einwilligungen und maximale klinische Informationen vorliegen.

Betreuende Kliniker

übersenden Einverständnis Mitbehandlung, klinischen Angaben (Briefe, möglichst Bildgebung-CD, minimale Angaben)


übermitteln Schnittpräparate / Wachsblöcke für die Beurteilung und wenn eben möglich etwas Gewebe in Glutaraldehyd (zur kostenfreien Erstellung von Epoxidblöckchen unter Erhalt der Lamellenkörperchen ggf. für Lungen-EMI)

an die

Dr. von Haunersches Kinderspital
Kubus, Room K0.10,
zHd Fr. Wesselak, Fr. Schams
Lindwurmstr 2a
80337 München

Weitere Info:

Mrs. Schams / Tel: +49 89 4400 53715; chILD-EU.register@med.uni-muenchen.de

4) Minimal clinical information

Please fill in the forms: English version PDF Icon Deutsche Version

I want inclusion into the register*

To include a case, please supply the following documents and materials:

For potential inclusion of the case in the register, please obtain your patient's informed consent. The consent forms for parents/caregivers, underage as well as adult patients can be downloaded via the Consent Forms Register page.

2) Case overview (Referral Letter/Epicrisis)

The case will be peer reviewed by international experts. For this purpose, a brief case overview in English (referral letter / epicrisis) will be required.

This letter can be sent by E-mail / regular mail / fax.

We also need completely filled out chILD visit sheets which can be used for the first and also for consecutive visits. Using these, you automatically capture all information necessary!

You may upload directly into the register if you already have a Data Capture Login and created a "New Patient".

3) Sample / Biomaterials

 Please send, using the sample shipping sheet,

  • ambient temperature immediatelly by regular mail: EDTA blood (always triplett: patient (5 -10 ml) + parents (10 ml)), wax block of lung tissue, slides of lung tissue
  • frozen: BAL, tissue

for details see (Labmanual)

Note: No delievery of samples possible on Fridays, Saturdays and Sundays.

Shipping Address 

SOP - Tissue for cells

4) Previous discharge letters (may be in local language)

The previous discharge letters can be send by e-mail*, regular mail or fax. You may upload the documents directly into the register if you already have a Data Capture Login and created a "New Patient".

5) Imaging (X-Ray-Thorax Series, CT)

The imaging data can be sent as CD by regular mail.

You may upload the DICOM files directly into the register if you already have a Data Capture Login.

However, as this may be cumbersome for the inexperienced, we recommend to send a pseudonymized CD, which we will upload for you.

If wished, we can provide you with a personal and secure link for upload of DICOM files in our databox system (please contact us by e-mail*).

* Take care to send pseudonomyzed documents.