|Brain Tumor Research Center Tissue Core
|1450 3rd Street, HD 210
|San Francisco, CA 94158
|415-443-7741 (BTRC Core pager)
|415-443-7743 (Tissue Acquistion OR pager)
CHR now requires a separate HIPAA Authorization in addition to our regular consent. Click here for updated consent and HIPAA forms.
Surrogate Signatures As of 10-30-11, the Tissue Bank was approved to allow surrogate consent. Surrogates may include spouse, parent, sibling, adult child or other appropriate adult. Use the same criteria for determining competency for surgical authorization. If a surrogate signed the surgical authorization, a surrogate may also consent to tissue banking.
Telephone Consent Telephone consent is NOT allowed. The subject or surrogate must personally write his/her own signature on the form. The person obtaining consent cannot do this for the subject or surrogate after talking to him/her on the telephone.
Signature of Person Obtaining Consent Consents MUST be signed and dated by the person who conducted the consent discussion.
Expired Consent Forms Each page of our Neurosurgery Tissue Bank consent includes the IRB Expiration Date in the top right corner. Please make sure the form you are using is current. Current versions of our consents are attached to this email and can be downloaded from our Tissue Bank Website. If you need hardcopies, please request from Alvin Au. 415-443-7743.
Pediatric Patients aged 7-18 In addition to parent/guardian consent, pediatric patients aged 7 and older, must assent to being in the study. See attached Assent document.
NOTE: It is best if properly signed and witnessed consent document is in the patient chart at the time of tissue collection. Please contact Tissue Bank Manager with any questions or concerns about the consent process: 415-502-7796
As of September 2007, the CHR considers use of pre-existing, de-identified samples as Non-Human Research.
What this means for Investigators
Investigators requesting de-identified tissue samples (SF# only), no longer need to apply for CHR certification. Instead, CHR suggests that investigators fill out a Self-Certifying Form to declare that certain conditions are being met. Please submit the completed Self-Certifying form to the Tissue Bank manager, Cynthia Cowdrey, when requesting samples.
The Tissue Bank will no longer provide patient identifiers or clinical information to investigators (e.g. MRNs) – regardless of their CHR status. Only the following information will be provided:
Investigators interested in pursuing further clinical information associated with tissue samples should contact Nataliya Volskaya, Manager of Neurosurgery Clinical Database; or Dr. Michael Prados or
Dr. Susan Chang at Neuro-Oncology Service.
- Tumor location
- Recurrent vs. newly-diagnosed
To learn more about the procedure of clinical data requisition, click here.