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Consent Form for Postnatal Exome Sequencing
Whole Exome Sequencing (EDT3)

Whole Exome Sequencing is a complex genetic test which aims to discover pathogenic variants in coding regions (exons) of genes associated with known genetic diseases and syndromes according to the OMIM® database.

I understand that this test may:

  1. Detect one or more variants which constitute the partial or complete genetic cause of the disease for which I was referred.
  2. Detect one or more variants which constitute the likely genetic cause of the disease for which I was referred, meaning likely pathogenic variants (Class 4) in genes possibly associated with the disease for which I was referred.
  3. Detect one or more variants whose clinical significance cannot be determined with the current bibliographic and other data – Variants of Uncertain/Unknown Significance (VUS).
  4. Not detect variants which constitute the genetic cause of the disease for which I was referred. Not identifying a variant does not exclude the possibility that the disease for which I was referred has a genetic etiology which was not detected in this test whether because it is located in a region (e.g intronic) not included in the analysis, or because it is a variant not detected by the methodology of the test (e.g large genomic rearrangements, trinucleotide repeat expansions etc.) or because it is located in a region which is not covered by a sufficient number of reads (~5% of the total exons) and therefore escapes analysis or it is located in a region where other quality parameters are not met, e.g regions with unbalanaced distribution of reads between alleles (strand bias) or it is a (likely) splicing variant which however is not recognized as such by the bioinformatics analysis platform Varsome Clinical which is used by our laboratory for the variant interpretation and therefore are ignored as findings and escape analysis.

I understand that I will not be informed about variants of uncertain significance except in specific cases according to the laboratory’s judgement and in agreement with the referring physician.  

I understand that variants of Uncertain Significance (VUS) which are not reported in the present analysis may be reported or reevaluated as likely pathogenic or pathogenic in a subsequent WES analysis if new clinical, phenotypic, scientific, or other data arise.

I understand that the variant interpretation is based on international literature and the Standards and Guidelines for the Interpretation of Sequence Variants of the American College of Medical Genetics and Genomics (ACMG guidelines). During the evaluation process the clinical information and the personal and family history provided to Access to Genome by me and/or the referring physician is used.  

I understand that in order to complete the variant interpretation it is possible to suggest the supplementary testing of other family members (parents, siblings etc).

I understand that in rare occasions the interpretation of a variant can change in the future based on new scientific data, which could result in a pathogenic variant becoming benign or vise versa.

Based on the methodology of the test, there is a possibility that secondary findings may be detected, meaning pathogenic variants in genes not associated with the disease for which I was referred. The ACMG has conducted a list of genes*, for which pathogenic variants cause severe diseases that require specific medical management. Because of the specific characteristics of these genes I am given the possibility to be informed for such secondary findings in the particular genes.  

I wish to be informed for pathogenic variants in the ACMG genes.  

□ YES  

□ NO  

I understand that I will not be informed for any other incidental findings (apart from those mentioned in the previous paragraph), e.g mutations in genes not associated with the disease for which I was referred and not included in the ACMG list, or single mutations in genes with recessive mode of inheritance according to the OMIM database, etc. Also, I will not be informed for any discrepancy in family relations (e.g non fatherhood, non motherhood). I understand that ATG holds the right to inform the referring physician for other incidental findings. In specific cases ATG and the referring physician hold the right to inform me for any incidental findings if that is considered useful for me or my family.

I understand that the Whole Exome Sequencing, like any other medical test has limitations. These include the inability to cover a small percent (~5%) of the analyzed exons, the inability to detect large genomic rearrangements, intronic variants, trinucleotide repeat expansions etc.  

I understand that ATG will store my personal data, the results of the genetic analysis and my sample for a period of up to 2 years depending on the ability to store digital data and biologic specimens.  

Please write your full name in capital letters and add your signature.

Patients/Parent/Guardian:  

Full Name:  

ID card number:  

Signature:

* ACTA2 ACTC1 ACVRL1 APC APOB ATP7B BAG3 BMPR1A BRCA1 BRCA2 BTD CACNA1S CASQ2 COL3A1 DES DSC3 DSG2 DSP ENG FBN1 FLNC GAA GLA HFE HNF1A KCNH2 KCNQ1 LDLR LMNA MAX MEN1 MLH1 MSH2 MSH6 MUTYH MYBPC3 MYH11 MYH7 MYL2 MYL3 NF2 OTC PALB2 PCSK9 PKP2 PMS2 PRKAG2 PTEN RB1 RBM20 RET RPE65 RYR1 RYR2 SCN5A SDHAF2 SDHB SDHC SDHD SMAD3 SMAD4 STK11 TGFBR1 TGFBR2 TMEM127 TMEM43 TNNC1 TNNI3 TNNT2 TP53 TPM1 TRDN TSC1 TSC2 TTN TTR VHL WT1 CALM1 CALM2 CALM3

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