Application For Mass Spectrometric Analysis
       Washington University Resource for Biomedical and Bio-organic Mass Spectrometry
                                   Department of Medicine
                      Division of Metabolism and Endocrinology - Box 8127
                           Washington University School of Medicine
                                   660 S. Euclid Avenue
                                    St. Louis, MO 63110
                       telephone: (314) 362-8190, FAX: (314) 362-8188
                          PLEASE PROVIDE ALL RELEVANT INFORMATION

	Investigator:_________________________		Bill to:___________________________	

	Address:______________________________		___________________________________

	______________________________________		___________________________________

	______________________________________		___________________________________

	Telephone:____________________________	 	Purchase Order No._________________ 	

Type of Analysis (circle one): Low resolution GCMS spectra, 13CO2 breath IRMS, 15N combustion IRMS, 2H218O IRMS, GCIRMS
tracer/tracee, GCMS tracer/tracee, GCMS quantitation, Other:____________________________    

				     FOR GCMS SPECTRA

Sample formula:_______________________________			Proposed Structure

Nominal Mol. Wt.:_____________________________

m.p. or b.p.:_________________________________

Purity:_______________________________________

Wt. sample submitted:_________________________

Soluble in which solvent?_____________________ 		Is sample stable in solution?_____ 		

Air sensitive?________________________________ 		Light Sensitive?__________________ 		

Moisture sensitive?___________________________ 		Heat sensitive?___________________ 		

Refrigerate?__________________________________ 		Return sample?____________________		

                    FOR IRMS and GCMS TRACER/TRACEE RATIO OR GCMS QUANTITATION:

Tracer administrated:_________________________ 		Tracee to analyze for:____________		

Internal Standard Preference:_________________ 	

Sample matrix: plasma, serum, urine, tissue,	Other:____________________________________	

Sample handling precautions: radioactive, infectious, moiture/heat sensitive.

    Patient ID				Sample date			Sample time points






Comments, precautions, additional information (Include hazards,handling, helpfull data, questions):

__________________________________________________________________________________________________

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IT IS STRONGLY ADVISED TO CONSALT WITH MASS SPECTROMETRY RESOURCE PERSONNEL PRIOR TO SUBMITTING
SAMPLES.