DEPARTMENT OF CLINICAL GENETICS
REQUEST FORM FOR FUNCTIONAL TESTING
Lynch syndrome gene variants with CIMRA test
 
 The section GD is NEN-EN-ISO 15189:2022 accredited by the Dutch Accreditation Council. The scope for accreditation number M007 can be found at www.rva.nl.

     Important information

  • Please fully complete the form (one form per patient)
  • For diagnostic turnaround times, our current criteria for diagnostic requests and opening hours, see our website.
  • The cost is €2,727 per variant tested. Submission of an email address is mandatory. An invoice will be issued, and once payment has been received, the CIMRA test will be initiated.
 
 Postal address
LUMC, Building 2
KG, Genome diagnostics S-06-P
Freepost 10392
2300 WB Leiden
The Netherlands

Visiting address/ Courier service:
Einthovenweg 20, 2333 ZC Leiden

Administration:
Tel: +3171-5269800
Email: genoomdiagnostiek@lumc.nl
Website: www.lumc.nl/en/afdelingen/clinical-genetics/
PATIENT INFORMATION
mm/dd/yyyy
  
 
REFERRING PHYSICAN
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MATERIAL
CIMRA = complete in vitro MMR activity test. No patient-specific material is required.

TEST
The CIMRA test is suitable for detecting loss of function due to amino acid changes.
The CIMRA test is not suitable for testing intronic variants, synonymous variants, or large insertions/deletions.

VARIANT INFORMATION
VERSION 1.0 - January 2026
 
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