Tzar Labs UK HrC Genomics PIF

Referred by:

The HrC Genomics Test is a blood test which evaluates the expression levels of rare stem cell markers which may be indicative of cancer. The information about the results of the HrC Genomics Test is given to you to raise your awareness and to inform your conversations with your healthcare provider, and does not determine or diagnose the condition of disease. Only a qualified physician can diagnose a condition or disease.

Are You Aged 18+?*

YesNo

Are You Pregnant?*

YesNo

Are you Postpartum (given birth with last 45 days)?*

YesNo

Are you HIV Positive/Seropositive?*

YesNo

Have you ever had hormone therapy and/or gender realignment surgery?*

YesNo

Please note that hormone therapy and/or gender realignment surgery can impact the results of the test, resulting in reduced accuracy. Please click "I understand and accept that hormone therapy and/or gender realignment surgery can impact the results of my test, resulting in reduced accuracy" if you would like to proceed with the test.

Sample Type

Date Sample Taken

Date

Time Sample Taken

:HourMinutes

First Name*

Last Name*

Date of Birth*

Email*

Phone Number*

Area CodePhone Number

Citizenship/Residency*

UK Citizen/ResidentEU Citizen/ResidentOther

Please specify your ethnic background*

Molecular markers can vary depending on the biological gender. The use of hormone therapy and gender realignment surgery can also affect molecular markers. This can impact the results of the test. Therefore, it is important to specify your assigned sex at birth.

Please specify your assigned sex at birth*

If Other, please provide details

Please select the option that best describes you*

I have no past or present history of cancerI am a Cancer Survivor

Is there a history of cancer in your family*

YesNo

Type of Cancer on Histology*

Date of Diagnosis*

Date of Last Treatment*

Type of Treatment*

TreatmentDetails*

This section provides details of the members of your family who have had had cancer, and their relationship to you. Only blood relatives need to be considered.

Relationship

Cancer Type

Age at Diagnosis

Relationship

Cancer Type

Age at Diagnosis

Relationship

Cancer Type

Age at Diagnosis

Please select the option that accurately describes your current status*

Trans FemaleTrans Male

Have you ever had hormone therapy?*

YesNo

Type of hormone therapy?*

Are you currently taking this therapy?*

YesNo

Date Started*

Date

Date Completed*

Date

Other Information

Have you had gender realignment surgery?*

YesNo

Type of Surgery*

Date of Surgery*

Date

Any complications after the surgery?*

History of Surgery*

YesNo

Type of Surgery*

Date of Surgery*

Any post-op complications*

Current Medications*

Do you have any Addictions*

Additional Comments

Steroids*

YesNo

Please provide details

Hormonal Therapy*

YesNo

Please provide details

Insulin*

YesNo

Please provide details

Testosterone*

YesNo

Please provide details

Oral Contraceptives*

YesNo

Please provide details

IVF*

YesNo

Please provide details

Have you received any growth factors (GCSF / Erythropoietin) in last 2 weeks?*

YesNo

Have you undergone any surgery in last 3 weeks?*

YesNo

Have you suffered from any infection (Covid, Malaria, Dengue, Viral Fever, etc) within the last 7 days?*

YesNo

What is your height?*

What is your weight?*

Do you smoke/vape?*

YesNo

How often do you consume alcohol?*

What was your age at menarche (first period) (if applicable)?

What was your age at menopause (if applicable)?

Do you work in an environment which possibly exposes you to radiation and/or carcinogen?*

YesNo

Have you had any infection (fever, cough, LMs, etc...) in last one month?*

YesNo

Have you experienced any unexplained loss (>5% of body weight) in the last 6 month?*

YesNo

Have you received a blood transfusion in last 2 weeks*

YesNo

Diabetes*

YesNo

Hypertension*

YesNo

Chronic Kidney Disease*

YesNo

Auto-immune Disorders*

YesNo

Thyroid Dysfunction*

YesNo

Heart Disease*

YesNo

Chronic Lung Disease*

YesNo

Allergies*

YesNo

Chronic Liver Disease*

YesNo

Disease/Dysfunction in Reproductive Organs (e.g. PCOD)*

YesNo

Other Comorbidities*

YesNo

Other Comorbidities Details

Process Overview

Tzar Labs UK Private Limited (Tzar Labs UK) and Tzar Genomics India Private Limited (Tzar Genomics) are wholly owned subsidiaries of 23IKIGAI Pte Ltd.

23IKIGAI Pte Ltd is the developer and owner of the HrC Genomics technology.

Samples for the HrC Genomics test are part-processed at the Tzar Labs UK laboratory in London and at the Tzar Genomics laboratory in Mumbai.

Tzar Genomics is an IQAS ISO15189:2022 Accredited Laboratory. Certificate Number: M-0008.

Tzar Labs UK operates a robust Quality Management System (QMS) that adheres to the standards of ISO15189:2022.

Tzar Labs UK is responsible for the extraction of RNA/DNA from blood samples for the purpose of whole exome and whole transcriptome sequencing using Next Generation Sequencing (NGS) technology. Extracted RNA/DNA samples that meet with the Quality Control requirements for whole transcriptome sequencing library preparation, are shipped to Tzar Genomics for further processing.

Tzar Genomics is responsible for arranging the whole transcriptome sequencing of the RNA/DNA samples and for the spectroscopy data acquisition. Tzar Genomics use a third party, MiBiome Therapeutics LLP, an ISO 9001 & 15189 certified laboratory, solely for the purpose of whole transcriptome sequencing.

The data generated from the whole transcriptome sequencing and the spectroscopy is analysed by a team of specialist doctors and scientists at Tzar Genomics, as to create the HrC Genomics test reports.

Ongoing Research

We conduct ongoing research for developing new scientific tests and related products. All samples provided to us and all tests conducted by us upon those samples may be used, in whole or in part, for further research purposes, and may be deidentified. Consent for us to utilise identifiable samples and/or identifiable data from those samples, including for the research purposes described, may be withdrawn at any time by contacting DataProtectionOfficer@tzarlabs.com.

Once samples and/or data have become deidentified, consent cannot be withdrawn for use due to lack of identifiability. For more information, please contact DataProtectionOfficer@tzarlabs.com

Data Protection

I understand that my data in the UK is protected under the data protection regulation - see https://www.gov.uk/data-protection for information on data protection in the UK.

Tzar Labs UK is registered with the Information Commissioner’s Office. Registration Reference: ZB888331.

In Mumbai, access to personal data is strictly restricted to the three signatories responsible for the signing of the HrC Genomics test reports. For analytical purposes, age and ethnicity are required to be shared with one team, but the individual’s date of birth is never shared.

I understand I may contact the Data Protection Officer on DataProtectionOfficer@tzarlabs.com if I have any concerns regarding the handling of my data.

I attest that the information and data provided by me is true and correct and I take complete responsibility regarding the accuracy of the same.

Consent

I authorise Tzar Labs UK and Tzar Genomics to process my blood sample for the purpose of generating an HrC Genomics test report for me. This includes the taking of a blood sample for the extraction of RNA/DNA from my blood sample for the purpose of whole exome and whole transcriptome sequencing using NGS technology.

Tzar Labs UK have advised me that I am not required to have an HrC Genomics test and did not seek to coerce or pressure me to sign this consent form.

I understand that Tzar Genomics will be unable to erase my test results, which are required as evidence of clinical practice.

I understand that Tzar Labs UK will be responsible for receiving my results and communicating them to me.

I understand that my deidentified blood sample, but not my data, may be shared and processed by third party processors.

I understand that machine learning and/or AI processing may be used in the processing of samples for the HrC Genomics test.

I understand the risks and limitations of the HrC Genomics test. I understand that the HrC Genomics Test is to be used for determining my risk of cancer.

The results of the test(s) are not intended to replace medical advice, nor should they be used as a full diagnosis, or to prescribe medication without consulting an appropriate medical professional.

I hereby release Tzar Labs UK and Tzar Genomics, its principals (including, where applicable, the technology licensor, 23Ikigai Pte Ltd., Singapore), directors, members, employees, affiliates, suppliers, providers, subcontractors, successors, agents, their respective insurance carriers, from any liability, injury or damage whatsoever arising from, or in any way connected with the Service or the administration of same including, but not limited to, acts of negligence, I have read and gone through the above CONSENT FORM, I have understood it and have no questions that have been left unanswered.

Patient's Signature or Signature of Guardian (if applicable)*

Name:*

Date*

Date

Please verify that you are human*

HrC Genomics Patient Information & Consent Form

Eligibility Criteria

Sample Details

Personal Information

Gender

Cancer Status

Cancer Survivor

Family History of Cancer

Transgender Information

Medical History

Have you taken any of the following medication in the last 2 weeks?

Important Information

Please answer the following questions:

Do you suffer from any of the following diseases:

PATIENT CONSENT