PerkinElmer Genomics Gene Tool

AnyPanel™ Custom (D3000) Gene Submission Tool

Directions

Please fill in all of the fields below including the submitting provider's name, patient's name, clinical indication for testing., and requested gene list.
A unique panel ID code will be generated upon submission. Please include this code in the appropriate box on the test requisition form to ensure appropriate processing.

Provider Name (first last)

Provider Email Address

Patient Name (first last)

Clinical Indication for Testing

Requested Genes

Please enter all requested genes for your custom panel below. Entry via copy and paste is accepted. Individual genes should be separated by a comma, single space, or one gene per line. Please note that currently only HUGO Gene Nomenclature will be accepted through this submission tool.

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