The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

ADDS-NiAD Kit Request System

Please enter your email address here to receive a confirmation email after completing the survey:

* must provide value

NiAD and/or ADDS Site

* must provide value

024 - USA: University of Pittsburgh

ATTN: Cathy Wolfe

Franklin Building Mezzanine
1011 Bingham Street
Pittsburgh, PA 15203

Phone: 412-235-5412
Email: wolfec@upmc.edu

027 - USA: Washington University - St. Louis

ATTN: Brittany Nelson
620 South Taylor Ave.
Suite 228A
St. Louis, MO 63110

Phone number: 314-286-0068
Email address: bmnelson@wustl.edu

961 - United Kingdom: University of Cambridge

Jessica Beresford-Webb
University of Cambridge
Department of Psychiatry
Addenbrookes Hospital
21 Fellows House,
Lilywhite Drive,
Cambridge,
CB4 1GP
UK
jb2192@medschl.cam.ac.uk

301 - USA: Barrow Neurological Institute

ATTN: Sandy Quintanilla
240 W. Thomas Road, Suite 301
Phoenix, AZ 85013

Phone: 602-406-7054
Email: Sandy.Quintanilla@DignityHealth.org

127 - USA: University of Wisconsin, Madison

ATTN: Renee Makuch
University of Wisconsin-Madison
Waisman Center
1500 Higland Ave. Room 550
Madison WI 53705

Phone: 608-262-4717
Email: makuch@wisc.edu

S01 - USA: Columbia University

ATTN: Deborah Pang
Columbia University Medical Center
G.H. Sergievsky Center
630 W. 168th St., Room PH 19-321
P&S Box 16
New York, NY 10032

Email: dip2104@cumc.columbia.edu
Phone: 212-342-1575

S02 - USA: Massachusetts General Hospital

ATTN: Dr. Diana Rosas
Department of Neurology
149 13th Street, Suite 10126
Charlestown, MA 02130

Phone: 617-726-0658
Email: rosas@helix.mgh.harvard.edu

S03 - USA: University of California, Irvine

ATTN: Kelley Kilday

UC Irvine
333 City Blvd. West, Suite 800
Orange, CA 92868

Phone: 949-824-8443
Email: kkilday@uci.edu
Email: kkilday@hs.uci.edu

Is the contact name above correct?

* must provide value

Yes

reset

New Contact Name

* must provide value

Is the shipping address above correct?

* must provide value

Yes

reset

New Shipping Address

* must provide value

Expand

Is the e-mail address above correct?

* must provide value

Yes

reset

New E-mail Address

* must provide value

NiAD Sibling Control Blood Kit Qty

NiAD DS Participant Blood Kit Qty

ADDS Blood Kit Qty

NiAD Frozen Blood Shipping Kit Qty

ADDS Frozen Blood Shipping Kit Qty

Blood Supplemental Supply Kit Qty

22G CSF Supplemental Supply Kit Qty
** Please specify which supplies needed from supplemental kit
***P1000 PIPETMAN Classic™ Pipet needs to be approved for request before sending

24G CSF Supplemental Supply Kit Qty
** Please specify which supplies needed from supplemental kit
***P1000 PIPETMAN Classic™ Pipet needs to be approved for request before sending

22G Lumbar Puncture Tray Kit Qty

24G Lumbar Puncture Tray Kit Qty

Frozen CSF Shipping Supply Kit Qty

Do you need Extra Supplies?

* must provide value

Yes

reset

25-Slot Cryobox

reset

Siliconized cryovial tubes (0.5ml) with clear cap

100

150

reset

Cryovial tubes (2.0 ml) with clear cap

100

150

reset

Disposable graduated transfer pipette

reset

FedEx return airbills
** UPS Airbill sleeves for U of Wisconsin

reset

Shipping container for dry ice shipment
(shipping and styrofoam box)

reset

Screw-top conical tube with blue cap (50 ml) - STERILE (Individually Packaged)

reset

Screw-top conical tube with blue cap (15 ml) - STERILE (Individually Packaged)

reset

Screw-top conical tube with orange cap (15 ml)

reset

P1000 Pipetman Classic Pipet
**Approval needed to send

reset

Sprotte 22G X 4 3/4" (120mm) needle (long)

reset

Sprotte 24G X 4 3/4" (120mm) needle (long)

reset

Sharpie Marker Pens

reset

Sprotte 22G X 3.5" (90mm) needle with Introducer

reset

Sprotte 24G X 3.5" (90mm) needle with Introducer

reset

Adhesive Spot Bandage

reset

Box of Alcohol Swabs

reset

Large Plastic Biohazard bag with absorbent sheet

reset

EDTA (Lavender-Top ) Blood Collection Tube (10 ml)

reset

Serum Separator (Gold-Top) Blood Collection tube (5 ml)

reset

Sodium Heparin (Green-Top) Blood Collection Tube (10 ml)

reset

Warning Label Packet - Blood Shipments

reset

Warning Label Packet - CSF Shipments

reset

Site and Subject ID Label

Site and NIAD ID Label

Preprinted universal blank labels - CSF

Please indicate the soonest date you will need supplies from this request:

* must provide value

M-D-Y

Comments

Expand

Each DS Study NiAD Sibling Control Blood Kit (118.1) Contains:

1: EDTA (Lavender-Top) Blood Collection Tube (10 ml) - CT001
21: Siliconized Cryovial tube (0.5 ml) with Lavender Sticker - CV020
1: Cryovial tube (2.0 ml) with Blue cap - CV034
1: Disposable graduated Transfer Pipette (3ml) - CV015
23: Pre-printed Collection and Aliquot Tube Label - LB003
3: Pre-printed Kit Number Label - LB003
3: Labels for Handwritten Site and NIAD ID - LB003
1: Cryovial Tube Box (25-Slot) - CV005
1: Resealable Tube Pouches (on roll) - SH032

Each DS Study NiAD DS Participant Blood Kit (103.1) Contains:

1: EDTA (Lavender-Top) Blood Collection Tube (10 mL) - CT001
2: Serum Separator (Gold-Top) Blood Collection Tube (5 mL) - CT007
21: Siliconized Cryovial tube (0.5 mL) with Lavender Sticker (Box 1) - CV020
21: Siliconized Cryovial tube (0.5 mL) with Red Sticker (Box 2) - CV020
1: 15 mL Conical tube
1: Cryovial tube (2.0 mL) with Blue cap - CV034
1: Disposable graduated Transfer Pipette (1 mL) - CV002
46: Pre-printed Collection and Aliquot Tube Label - LB003
4: Pre-printed Kit Number Label - LB003
4: Labels for handwritten Site and NIAD ID - LB003
2: Cryovial Tube box (25-Slot) - CV005
1: Resealable Bag - ST002
1: Resealable Small Poly Bag (4x6") - ST010

Each DS Study ADDS Blood Kit (106.1)Contains:

1: EDTA (Lavender-Top) Blood Collection Tube (10 mL) - CT001
2: Serum Separator (Gold-Top) Blood Collection Tube (5 mL) - CT007
21: Siliconized cryovial tube (0.5 mL) with Lavender sticker - CV020
21: Siliconized cryovial tube (0.5 mL) with Red sticker - CV020
1: 15 mL Conical - CV004
1: Cryovial tube (2.0 mL) with Blue cap - CV034
1: Disposable graduated Transfer Pipette (3 mL) - CV015
46: Pre-printed Collection and Aliquot Tube Label - LB003
4: Pre-printed Kit Number Label - LB003
4: Labels for handwritten Site and Subject ID - LB003
2: Cryovial Tube box (25-Slot) - CV005
1: Resealable Small Poly Bag (4x6") - ST010

Each NiAD Frozen Blood Shipping Supply Kit (104) Contains:

5: Large Plastic Biohazard bag with Absorbent Sheet (250ml) - SH025 + SH028
1: FedEx Return Airbill (UPS airbill sleeve for U of Wisconsin) w/Waybill - SH002
1: Shipping box/Styrofoam container (Large) - SH003
1: Warning Label Packet with dry ice sticker (Dry Ice, UN3373, Fragile) - LB005, LB008, SH048
1: Resealable Bag - ST002

Each ADDS Frozen Blood Shipping Supply Kit (107) Contains:

5: Large Plastic Biohazard bag with Absorbent Sheet (250ml) - SH025 + SH028
1: FedEx Return Airbill w/Waybill Sleeve - SH002
1: Shipping box/Styrofoam container (Large) - SH003
1: Warning Label Packet with Dry Ice sticker (Dry Ice, UN3373, Fragile) - LB005, LB008, SH048
1: Resealable Bag - ST002

Each DS Study NiAD/ADDS Blood Supplemental Kit (105.2) Contains:

10: Siliconized Cyovial tube (0.5 ml) with Clear cap with Lavender Sticker - CV020
10: Siliconized Cryovial tube (0.5 ml) with Clear cap with Red Sticker - CV020
5: 15 mL Conical - CV004
5: Cryovial tube (2.0 ml) with Blue cap - CV034
5: Cryovial Tube box (25-Slot) - CV005
5: Disposable graduated Transfer Pipette (1ml) - CV002
5: EDTA (lavender top) blood collection tube (10 ml) - CT001
10: Serum Separator Tube (Gold Top) blood collection tube (5 ml) - CT007
10: Labels for handwritten Site and Subject ID - LB003
20: Sodium Heparin (Green-Top) Blood Collection Tube (10 ml) - NIAD ONLY - CT008

Each DS Study NIAD/ADDS 22G CSF Supplemental Kit (101.1 OR 101 w/Pipetman) Contains:

10: 50ml Conical individually wrapped-Sterile - CV056
20: 15ml Conical individually wrapped-Sterile - CV029
3: Shipping box/Styrofoam container (Small) - SH005
3: Pre-printed airbills/shipping labels w/Waybill - SH002
3: Dry Ice Shipping Label - LB005
3: Exempt Human Specimen Label - LB007
3: Resealable Plastic Bag - ST002
3: Sealable Bubble Wrap Bag - ST019
3: Absorbent Tube Sleeve - SH018
10: LP Requisition forms
100: Pre-printed Universal blank labels for 50 ml conical tubes and 500 ul aliquot tubes - LB003
4: Sharpie Marker Pens
5: Extra Sprotte 22G X 3.5" (90mm) needle with Introducer (Pajunk #021151-30C) - LP006
3: Extra Sprotte 4 3/4" 22G needles - LP011
1 set: Sterile gloves (5 pair Medium and 5 pair Large) - BP025 + BP026
10: Adhesive Spot Bandage - BP022
100: Alcohol prep pad - BP015

BY REQUEST ONLY:
1: Bel-Art™ SP Scienceware™ No-Wire™ Multi-Size Centrifuge Tube Racks - CV033
1 Tray of 96: 500-µl aliquot tubes (Thermo Scientific #3743)
1 Rack (96) AVANT® 1250-µL Low Binding, Sterile Pipette Tips (Midest Scientific AVR1250SH) - CV031
1: P1000 PIPETMAN Classic™ Pipet (Gilson F123602) - APPROVAL NEEDED BEFORE SENDING - CV032

Each DS Study NIAD/ADDS 24G CSF Supplemental Kit Contains:

10: 50ml Conical individually wrapped-Sterile - CV056
20: 15ml Conical individually wrapped-Sterile - CV029
3: Shipping box/Styrofoam container (Small) - SH005
3: Pre-printed airbills/shipping labels w/Waybill - SH002
3: Dry Ice Shipping Label - LB005
3: Exempt Human Specimen Label - LB007
3: Resealable Plastic Bag - ST002
3: Sealable Bubble Wrap Bag - ST019
3: Absorbent Tube Sleeve - SH018
10: LP Requisition forms
100: Pre-printed Universal blank labels for 50 ml conical tubes and 500 ul aliquot tubes - LB003
4: Sharpie Marker Pens
5: Extra Sprotte 24G X 3.5" (90mm) needle with Introducer (Pajunk #021151-30C) - LP010
3: Sprotte 4 3/4" 24G needles - LP012
1 Set: Sterile gloves (5 pair Medium and 5 pair Large) - BP025 + BP026
10: Adhesive Spot Bandage - BP022
100: Alcohol prep pad - BP015

BY REQUEST ONLY:
1: Bel-Art™ SP Scienceware™ No-Wire™ Multi-Size Centrifuge Tube Racks - CV033
1 Tray of 96: 500-µl aliquot tubes (Thermo Scientific #3743)
1 Rack (96) AVANT® 1250-µL Low Binding, Sterile Pipette Tips (Midest Scientific AVR1250SH) - CV031
1: P1000 PIPETMAN Classic™ Pipet (Gilson F123602) - APPROVAL NEEDED BEFORE SENDING - CV032

Each 22G Lumbar Puncture Tray Kit (LP005) Contains:

1: Sprotte needle, 22G X 3.5" (90mm)
1: Introducer needle, 1 mm x 30 mm
1: Hypodermic needle, 22G x 1.5"
1: Plastic syringe, (3 ml, luer lock) with 25G x 5/8" needle attached
4: Polypropylene syringe (6 ml, Luer lock)
1: Needle stick pad
1: Adhesive bandage
1: Drape, fenestrated, 2 tabs, paper, 18" x 26"
2: Towel, 13.5" x 18"
6: Gauze pad, 2" x 2"
3: Sponge stick applicator
2: Lidocaine 1%, 5 ml
1: Povidone-Iodine Topical Solution, 0.75 oz

Each 24G Lumbar Puncture Tray Kit (LP002) Contains:

1: Sprotte needle, 24G X 3.5" (90mm)
1: Introducer needle, 1 mm x 30 mm
1: Hypodermic needle, 22G x 1.5"
1: Plastic syringe, (3 ml, luer lock) with 25G x 5/8" needle attached
4: Polypropylene syringe (5 ml, Luer lock)
1: Needle stick pad
1: Adhesive bandage
1: Drape, fenestrated, 2 tabs, paper, 18" x 26"
2: Towel, 13.5" x 18"
6: Gauze pad, 2" x 2"
3: Sponge stick applicator
2: Lidocaine 1%, 5 ml
1: Povidone-Iodine Topical Solution, 0.75 oz

Each DS Study NIAD/ADDS Frozen CSF Shipping Supply Kit (102) Contains:

1: Shipping box/Styrofoam container (Small Frozen Shipper) - SH005
1: Pre-printed airbills/shipping labels w/Waybill - SH002
1: Dry Ice Shipping Label - LB005
1: Exempt Human Specimen Label - LB007
1: Resealable Plastic Bag - ST002
1: Single Use - Sealable Bubble Wrap Bag - ST019
1: Absorbent Pad - SH018

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.