DNA – application form
Healthcare providers can download the Application Form.
DNA diagnostics
Step 1: Start DNA Diagnostics for FH, 2 options
- Healthcare provider uses DNA request form, or
- Patient (family member) requests test kit from LEEFH and then contacts (family) doctor.
Via dit formulier kunnen 2 soorten DNA -onderzoek worden aangevraagd (zie voor kosten en privacy)
- Comprehensive panel (no known genetic FH variant in the family).
- Targeted panel (family history, known genetic FH variant in the family).
Step 2: Fill in the application form
The healthcare provider and patient complete the application form. The application form consists of a questionnaire for the physician and a questionnaire with informed consent for the patient. With the informed consent, Amsterdam UMC can share your data and results with Stichting LEEFH. It is important that both are completed and signed.
Step 3: Blood draw and results
The patient then goes to a blood collection center in the region for a blood sample. The blood sample and request form are sent to Amsterdam UMC (address is on the request form) by the blood collection center. The requesting healthcare provider receives the results from Amsterdam UMC.
Step 4: Family history
If test results confirm a family history of FH, LEEFH will contact the patient to arrange a family screening.
