Table of Contents

Retinoblastoma Genetic Testing
- - Impact Genetics Lab Forms
  - Epic Ordering

Retinoblastoma Genetic Testing

Download and complete the Impact Genetics Lab forms
Order the test in Epic
Draw the blood
Obtain the tumor tissue if applicable
Send the Impact Genetics forms with the sample(s)

Impact Genetics Lab Forms

Access the Impact Genetics Requisition Packet online .
- Print the Testing Requisition packet, Consent and the Sample Instructions.
Partially prefilled forms here (updated April 3, 2022):
Download

Epic Ordering

Lab7505 RB1 Gene Analysis full sequence, bilateral, blood
Lab7506 RB1 Gene Analysis full sequence, unilateral, blood
Lab7507 RB1 Gene Analysis full sequence, tumor
Lab3621 Miscellaneous Test (use for family members, known mutation) – free text in the comment section “whole blood to be shipped to Impact Genetics, Toronto, Canada for known familial mutation”.
This will go to the lab and then UIHC Mail Out Service 6-8593