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[]
[{"$nulls":4},"Form Approved"]
[{"$nulls":4},"OMB No. 0920-0879"]
[{"$nulls":4},"Exp. Date 01/31/2021"]
[null,"Newborn Screening Quality Assurance Program"]
[]
[null,"    Survival Motor Neuron 1 (SMN1) Exon 7 Analysis in Dried-Blood Spots "]
[null,"To Detect Spinal Muscular Atrophy (SMA)\nPilot Proficiency Testing Program (Pilot SMAPT) "]
[null,"Note: Any data submission form which is NOT current OR has been altered will NOT be accepted"]
[]
[null,"Proficiency Testing:        \nPilot PT Program",null,"Issued: June 15, 2020                                 \nData Reporting Deadline:          \nJuly 10, 2020"," Email your complete worksheet to        \nIrene Williams at NSQAPDMT@cdc.gov \nThe phone number is 770-488-7024"]
[]
[null,"NSQAP Laboratory Code:"]
[null,"Select Method Code from drop-down menu:\nLDT refers to Lab Developed Test\nRUO refers to Research Use Only"]
[null,"If Other selected, YOU MUST list commercial method or describe lab developed test:"]
[null,"Select DNA Extraction Method from drop-down menu:"]
[null,"If Other selected, YOU MUST describe:"]
[null,"SMN1 assay primer and probe information*"]
[null,"SMN1 probe sequence including dye and quencher:"]
[null,"SMN1 forward amplficiation primer sequence:"]
[null,"SMN1 reverse amplficiation primer sequence:"]
[null,"Reference Gene assay primer and probe information*"]
[null,"Select Reference Gene from drop-down menu:"]
[null,"If Other selected, YOU MUST specify gene name and symbol:"]
[null,"Reference gene probe sequence including dye and quencher:"]
[null,"Reference gene forward amplficiation \nprimer sequence:"]
[null,"Reference gene reverse amplficiation \nprimer sequence:"]
[null,"*Input \"not available\" in the Other secion of each probe category if using a commercially available assays for which this information is not available."]
[]
[]
[null,"Specimen Number ","Analyte","Clinical Assessment Code\n(Select from Drop-down Menu)                                                                  ","Comment"]
[]
[null,"20P1701","SMN1 Exon 7"]
[null,"20P1702","SMN1 Exon 7"]
[null,"20P1703","SMN1 Exon 7"]
[null,"20P1704","SMN1 Exon 7"]
[null,"20P1705","SMN1 Exon 7"]
[]
[]
[]
[]
[null,"LIST OF METHOD CODES",null,null,"LIST OF REFERENCE GENES"]
[null,"1  LDT Real Time PCR - SMN1 only (reference gene run seperately)",null,null,"1   RNaseP subunit (RPP30)"]
[null,"2  LDT Real Time PCR - SMN1 AND Reference Gene run in a single tube",null,null,"2   RNaseP subunit (RPPH1)"]
[null,"3  LDT Real Time PCR - SMN1/TREC AND Reference Gene run in a single tube",null,null,"3   Beta-actin (ACTB)"]
[null,"4  RUO Perkin Elmer Real Time PCR - SMN1/TREC AND Reference Gene run in a single tube",null,null,"9   Other"]
[null,"9  Other "]
[]
[]
[]
[null,"LIST OF DNA EXTRACTION METHODS",null,null,"LIST OF ASSESSMENT CODES"]
[null,"1    In situ/on card (DNA is NOT extracted)",null,null,"1  Screen Negative (no follow up required)"]
[null,"2    Perkin Elmer DNA Extraction Solution",null,null,"2  Screen Positive (SMN1 out of range, reference gene in range)"]
[null,"3    Generation™ DNA Purification and Elution Solutions (S1/S2)",null,null,"3  Unsatisfactory sample (SMN1 and reference gene out of range)"]
[null,"4    Generation™ DNA Elution Solution (S2 only)"]
[null,"5    Extracta™ DBS with no wash"]
[null,"6    Extracta™ DBS with one wash"]
[null,"9    Other"]
[null,"Participating laboratories must generate and submit their own results and must not share NSQAP Pilot PT test results or specimens with any other laboratory under ANY circumstance, even if the laboratory normally sends specimens to referral laboratories for routine or confirmatory testing. If participants are found to have falsified or shared results or specimens, the NSQAP committee will convene to discuss response actions for the participant which may include termination from the program."]
[null,"Use of trade names is for identification only and does not imply endorsement by the Public Health Service, the U.S. Department of Health and Human Services, or the Association of Public Health Laboratories."]