CO 



to 

 o 



CO 



w 



H 

 to 



< 



M 



w 

 « 

 o 

 o 



Breakage/Somatic Rearrangements? 

 [T] Data Not Available 2 Data Available 



(T) J Breaks Observed 



[2~| ^ Somatic Rearrangements 



5 Observed 



^ [3] Neither Observed 



o 19. Current International Nomenclature: ______ 



CO 



o 



2 



O 



20. The Above Karyotype is Based on \T\ Banded or _] Unbanded 

 Technique (s ) . 



21. If Banded, what Staining Method(s) was Used: 



22. Have Biochemical Studies been Done on this Individual 

 __ No (Go to Item 29) 



CD Yes 



|T| On Cells from this Culture (Go to Item 23) 

 jT| On Other Cultures or Tissues from Same Patient (Go to 

 Item 28) 



23. Specific Defect Detected or Investigated: 



24. Assay Method Used: 



25. Assay Level in this Cell Culture: 



3 26. Assay Level in Normal Control Cell Cultures 



27. Conclusion Based on Biochemical Assay: 



[T] Normal |T| Abnormal [3] Inconclusive 



Consistent with Heterozygosity 

 [T| Consistent with Homozygosity 

 j3] Genotype Uncertain 

 [3 Not Applicable 



20 



