28. Significant Laboratory Data on Other Cell Cultures or Tissues from 

 this Individual : 



29, 



Is Pedigree Available? No 



Yes 



CO 

 CO 



o 

 ►J 

 u 



55 

 W 



CO 



H 



55 



31. 



32. 



33. 



Has this Pat ient /Family been Reported in Literature? 

 [j] No LH Yes 



Specify Reference 



Has a Sample from this Patient been Previously Stored in Camden? 

 Q] No [3 Yes, GM # . 



Any Additional Comments/Observations/References/Lab Studies on 

 Culture, Patient, Family Etc.? 



o 

 c_> 



Enclosures: [JJ Pedigree |T) Clinical History/Description of 



Patient and/or Family 

 [31 Karyotype {U\ Laboratory Data on Patient/Family 

 [31 Reprint of Reference \b\ Other 



(Specify) 



21 



