MITOMAP mtDNA Variant Submission (Archived Copy of Original Form)

  • Submit unpublished human mtDNA polymorphisms (point mutations, micro-insertions, or micro-deletions).
  • Fields marked with red asterisks must be completed
  • Values are automatically taken from your user profile.
  • To modify data previously submitted, login as the user who submitted the entry.
  • Send your questions to

Submitter Information:

Fields marked ** are required
Last Name: **
First Name:
Middle Name/Initial:
E-mail address: **
Organization name:
Organization URL:
Country: **

Lab Information:

Fields marked ** are required
Lab Chief/PI Last Name: **
Lab Chief/PI First Name:
Lab Chief/PI Middle Name/Initial:
Lab Chief/PI Email: **
Other Contributor(s):

Sample Information:

Please assign a unique sample identifier to the individual(s) whose DNA is being reported. If you do not have a unique identifier, please create one. Use alpha-numeric characters only and do not use family names to ensure patient confidentiality. This ID will allow determination of "linkage" (mutations found in the same individual).
Fields marked ** are required
Sample Identifier: **
Method of Detection: manual automated chip based other
Heteroplasmy Detected: no yes
Tissue Tested: blood muscle fibroblasts tumor other

Variant Information

Other Information:

Patient Group/Phenotype: e.g LHON, diabetes, control/normal
Racial/Ethnic Group: e.g. Bushman, Hispanic, Eskimo
Country or Region of Origin: e.g. Canada, Japan, Siberia

Topic revision: r1 - 08 Jan 2016, UnknownUser

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