MEN2 Database Submission Form

Please fill out this form to submit new RET sequence variation to the MEN2 RET database. This form should also be used to update clinical information or to clarify phenotype of RET sequence variation already in the database. Submissions will be reviewed before being added to the database and the submitter may be contacted if clarification or additional information is needed. For this reason, valid contact information is required to make a submission.

If you have any questions or concerns about the submission process please send an email to Rebecca Margraf at ARUP Laboratories.

Required Fields *

Sequence Change 1

Example: 618(TGC-CGC).
Example: C620R.
Example: c.1900T>A.

Note: Use the HGVS sequence variation nomenclature to generate the RET genotypes.

  No additional sequence changes

Sequence Change 2

Example: 618(TGC-CGC).
Example: C620R.
Example: c.1900T>A.

Clinical Consequences

Patient’s age of onset (in years)
If patient was affected, but age of onset is unknown, mark with an X. If patient was not affected, mark with an NA.

Family History

Number of Each Gender
Please include the patient, as well as any family members for whom you are providing clinical descriptions. Our current IRB requires tracking the total number of males and females included in MEN2 RET database submissions.

Additional Information

Contact Information

   Display my email address with my contact information for this submission