1Signature Genomic Laboratories, LLC, 2820 N. Astor St., Spokane, WA 99207, USA2Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA3Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA4Weisskopf Child Evaluation Center, University of Louisville, Louisville, KY, USA5Cheyenne Children's Clinic, Cheyenne, WY, USA6Department of Molecular and Human Genetics, Indiana University School of Medicine, Indianapolis, IN, USA7Department of Medical Genetics, Carle Clinic, Bloomington, IL, USA8Department of Medical Genetics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA9Children's Hospital Central California, Madera, CA, USA10Sacred Heart Medical Center, Spokane, WA, USA11WWAMI Medical Education Program, Washington State University, Spokane, WA, USA12School of Molecular Biosciences, Washington State University, Spokane, WA, USA