European Cytogeneticists Association
Register of Unbalanced Chromosome AberrationsDepartment of Human Genetics
Radboud University Medical Center
P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
Tel: +31 (0) 24 361 3799, Fax: +31 (0) 24 361 6658
E-mail: /
Request for detailed case information
Note: detailed case information is only available to accountholders of the ECARUCA database
Please fill in the following information directly into this Word document to obtain detailed case information for an aberration from the ECARUCA database:
Name and initials:
Title:
Profession:
Name institute/hospital:
Address, PO Box, City:
Phone number:
Email:
Website address (optional):
Aberration of interest:
Reason for current request (please tick):
Parent contact
Research
Publication
Other (please specify):
Before signing this form, please read the following regulations and disclaimers:
In order to prevent misuse of the data and to ensure copyright regulations, requests will need approval by theDaily Management Team if the data are to be used for research or publishing purposes. The center that originally submitted the data will be consulted on the request, and has to give permission prior to the use of the data in any publication.
ECARUCA does not make warranties of any kind concerning the accuracy and suitability of the information from the ECARUCA database. ECARUCA does not accept responsibility or liability for the accuracy and suitability of data from the database, the use of data from the database and any claims, damages, expenses and losses as a result of the use of the data from the database by a third party.
/European Cytogeneticists Association
Register of Unbalanced Chromosome AberrationsDepartment of Human Genetics
Radboud University Nijmegen Medical Center
P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
Tel: +31 (0) 24 361 3799, Fax: +31 (0) 24 361 6658
E-mail: /
Request for detailed case information (continued)
Please print and sign this form and send it to the following address:
ECARUCA (for the attention of M. Reijnders)
Department of Human Genetics, 848
Radboud University Medical Centre
P. O. Box 9101
6500 HB Nijmegen
The Netherlands
I have read and understood the regulations and disclaimers outlined above.
Date: ……………………………………………… Signature: …………………………………………….
Margot Reijnders, MD (Clinical Database Manager) Rita Dirks (Database Manager)
Nicole de Leeuw, PhD (Daily management ECARUCA) E-mail:
(2015-05)