Home » chILD-EU Register » I have a case

I want patient referral/support

 

1) Confidentiality releaseSchweigepflichtsentbindung

When referring a patient for diagnosis or treatment advice, we need consent of the family. This is independent of the inclusion into the register, for which a separate consent form is necessary (available below).

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

For (pre-register) reference pathology please use this form (German).


I want inclusion into the register*

To include a case, please supply the following documents and materials (you may upload them yourself or send to Munich central site for upload):


1) Signed patient consent form

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".

Alternatively, we may upload the documents for you.

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

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

You may also 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 CD, which we will upload and automatically pseudonymize 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.