PerkinElmer Genomics

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 gene or panel ID code will be generated upon submission. When using our standard paper Single Gene and Panel Testing Requisition Form, please include this code in the GENE OR CUSTOM PANEL ID box to ensure timely processing.

Provider Name (First Last)*

Provider Email Address*

Patient Name (First Last)*

Clinical Indication for Testing*

Leave blank

Requested Genes

Please enter all requested gene symbols for your custom panel below. Entry via copy and paste is accepted. Individual gene symbols should be separated by a comma, single space, or one gene symbol per line. Please note that currently only HUGO Gene Nomenclature Committee (HGNC) approved gene symbols will be accepted through this submission tool. In addition, this submission tool does not guarantee complete coverage of the genes. Please utilize the Exome and Panel Coverage Tool to verify specific gene coverage: https://apps.perkinelmergenomics.com/gene-coverage/.

Leave blank