Before we can move forward with the transfer of samples we will need to obtain permission in the form of Informed Consent.
UCLA HIPAA Authorization Form:
This is permission from your hospital or medical care provider to release medical information. To protect confidentiality all personally identifiable information is stripped from any donated material entering the tissue bank and it is replaced with a unique code. The tissue bank will collect the following non-identifiable clinical information: Age at seizure onset, age at surgery, seizure frequency at time of surgery, list of anti-epileptic drugs (AEDs) and immune therapy prior to surgery, de-identified MRI images and de-identified surgical pathology report.