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Cordlife Clients

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Request for Release of Child's Umbilical Cord Sample/s

This page is for Cordlife Philippines clients with samples stored at Cordlife. Please complete the form below to request the processing and release of your child's umbilical cord sample. Detailed information about Cordlife's procedures can be found in the guidelines below the form.

Indicates required field
Type of Service for Release
Umbilical Cord Blood
Umbilical Cord Lining
Umbilical Cord Tissue
Expanded Mesenchymal Stem Cells
*Owner of the sample
For transfusion request: Name of the hospital for transfusion
For transfer request: Name of the receiving facility
Contact Person from Hospital/Receiving Facility
*Must be 15 working days from the date of receipt of the Doctor's Order. Weekends are not valid.
Kindly select from 8:00 AM to 5:00 PM only, with 30 minutes interval.
Kindly upload (1) valid ID.
One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png.
Preferred Courier

Guidelines for the Release of Your Child’s Umbilical Cord Sample/s

To assist you with the release process of your child’s umbilical cord sample/s, please follow the steps outlined below. A Cordlife Customer Care representative will coordinate closely with you to ensure a smooth process, including documentation, processing, and sample transport.

  1. Consult your chosen transplant physician for assessment.
  2. Upon approval of the transplant physician and upon completion of all requirements, your physician will provide you with a doctor’s order to request the release of the umbilical cord blood sample. You may upload the said request through the form above.
  3. After we have received your request with the doctor’s order, we will be requesting you to sign the following documents:
    • For transfer of facility
      • Limitation of Liability
      • Release Form for Transfer of (UCB/UCL/UCT/MSCx) Unit
    • For transfusion
      • Request for Issue of Umbilical Cord Blood Unit
      • Letter of Indemnity.
    • Upon receipt, an acknowledgment letter from our Medical Director shall be sent to you. 
  4. Your designated transplant physician will be then briefed by our Medical Director on our distribution and issue procedures for the umbilical cord sample unit. 
  5. A meeting between the Medical Director, Laboratory Director and all relevant parties from the facility receiving the umbilical cord samples will be arranged. 
  6. Cordlife will confirm the time and date of umbilical cord sample delivery, no more than 7 days and no less than 2 days prior to the agreed date. 
  7. The umbilical cord sample will be delivered to the hospital or storage facility on the actual date of transfusion or transfer.
     
If you wish to withdraw/amend your consent to process your information, kindly send us an email at dpo.ph@cordlife.com.