DNA SEQUENCING LABORATORY                                                    Date

Department of Microbiology/Immunology

UAMS, Rm 504

4301 W. Markham

Little Rock, AR 72205-7199

(501) 686-6927  

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Read and sign the following.  Your samples will not be processed without a signature!

I hereby confirm that these samples are intended for research purposes only and will in no way be used to make any diagnostic or therapeutic decisions impacting patient care.  Additionally, my signature represents that, as applicable, I have IRB approval for the use of these samples.   

                                                         

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