Requisitions

Requisition Generator

Use the requisition generator to create a PDF with pre-populated healthcare provider information, including Connect Care identifiers.

Available Requisitions

  • General Laboratory Requisition (All Zones)
  • Gynecological Cytopathology Requisition (North Zone, Edmonton Zone)
  • Microbiology Requisition (North Zone, Edmonton Zone, South Zone, Central Zone)

Full List of Requisitions

Requisition Name or Number Discipline Zone
COVID-19 Test Requisition Form - 21823 COVID-19 North
Microbiology Requisition - 20571 Microbiology North, Edmonton, Central, South
Transfusion Medicine - 21448 Transfusion Medicine North
Laboratory Add-on/Order Modification Requisition – CH-0679 Pre-Analytics Provincial Documents (all zones)
Chemistry Specialty Requisition - CH-0311 Chemistry Edmonton
COVID-19 Test Requisition Form - 21823 COVID-19 Edmonton
Hematology Specialty Requisition - CH-0312 Hematology Edmonton
Histocompatibility Requisition - CH-0319 (Edmonton) Histocompatibility Edmonton
Maternal Prenatal Screen Requisition - CH-1247 (Edmonton & area) - Edmonton
Nongynecologic Cytopathology Requisition - 20984 Cytopathology Edmonton
Rapid HIV Antibody Test Request - 18634 - Edmonton
STAT Requisition - CH-0022 Pre-Analytics Edmonton
Transfusion Medicine - CH-0025 Transfusion Medicine Edmonton
Immunohistochemistry Request Form - Edmonton Anatomical Pathology Edmonton
Immunohistochemistry Request Form - Calgary Anatomical Pathology Calgary
Nongynecologic Cytopathology Requisition - 20444 Cytology Central
Adult Autopsies Infosheet Completion Aid Anatomical Pathology Central
Requesting Pediatric-Stillborn Autopsies from Red Deer Hospital - Central and North Zone Completion Aid Anatomical Pathology Central
COVID-19 Test Requisition Form - 21823 COVID-19 Central
Spinal Fluid Collection Protocol - 09393 Pre-Analytics Central
Transfusion Medicine - 21448 Transfusion Medicine Central
COVID-19 Test Requisition Form - 21823 COVID-19 Calgary
COVID-19 Test Requisition Form - 21823 COVID-19 South
Nongynecologic Cytopathology Requisition - 101945 Cytology South
Bone Marrow Request - FC-1017 (Chinook Regional Hospital Lethbridge) Hematology South
Transfusion Medicine - 21448 Transfusion Medicine South
Specimen Collection Kit / Requisition Order Form Public Health Provincial Laboratory for Public Health (ProvLab)
Add On Test Fax Form - 20721 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Bacteriology Culture and Serology Requisition - CH-0039 (ProvLab North - Edmonton) Public Health Provincial Laboratory for Public Health (ProvLab)
Bacteriology Requisition - 20691 (ProvLab South - Calgary) Public Health Provincial Laboratory for Public Health (ProvLab)
Blood and Body Fluid Exposure - 21150 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Bone Marrow Transplant Testing Requisition - 19581 (ProvLab South - Calgary) Public Health Provincial Laboratory for Public Health (ProvLab)
Deceased Organ Donor Requisition - 20116 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Living Donor Infectious Disease Screening Requisition - 20829 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Malaria PCR Requisition - 20722 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Prenatal Testing Requisition - 21151 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Reference Organism and Surveillance Requisition - 19193 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Serology and Molecular Testing Requisition - 20676 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Solid Organ Transplant (ADULT) Recipient Screening - 20970 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Solid Organ Transplant (PEDIATRIC) Recipient Screening - 20971 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Solid Organ Post Transplant Follow Up - 20972 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Tissue and Bone Marrow Transplant Donor Testing Requisition - 21278 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
Zoonotic Serology Requisition - 20087 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)

_General Laboratory Requisition - 21302

Pre-Analytics Provincial Documents (all zones)
Blood and Body Fluid Exposure - 21150 (Cross-site) Pre-Analytics Provincial Documents (all zones)

Anatomical Pathology Consultation Request - 19027

Anatomic Pathology Provincial Documents (all zones)
Autopsy Consent and Consultation Request - 20597 Anatomic Pathology Provincial Documents (all zones)

Laboratory Services Vitamin D (25-Hydroxy) - 19500

Chemistry Provincial Documents (all zones)
Biochemical Genetics Laboratory Requisition - 18521 (Calgary) Genetics/Genomics Biochemical Genetics Laboratory/Newborn Metabolic Screening
Chemistry Specialty Requisition - CH-0311 Genetics/Genomics Biochemical Genetics Laboratory/Newborn Metabolic Screening
Maternal Prenatal Screen Requisition - CH-1247 (Edmonton & area) Genetics/Genomics Biochemical Genetics Laboratory/Newborn Metabolic Screening
Constitutional Cytogenetics Requisition - 21248 (North and South) Genetics/Genomics Cytogenetics Laboratory
Hematology Specialty Requisition - CH-0312 (Edmonton Laboratory) Genetics/Genomics Cytogenetics Laboratory
Chromosomal Microarray (CMA) Requisition - 09591 (North and South) Genetics/Genomics Cytogenetics Laboratory
Molecular Diagnostic Laboratory Requisition - 18522 (Calgary Laboratory) Genetics/Genomics Molecular Genetics Laboratory
Molecular Diagnostic Laboratory Requisition - CH-0854 (Edmonton Laboratory) Genetics/Genomics Molecular Genetics Laboratory
Cancer and Endocrine Next Generation Sequencing Requisition - 20897 (Provincial Requisition) Genetics/Genomics Molecular Genetics Laboratory
Molecular Pathology Requisition - CH-1230 Molecular Pathology Molecular Pathology
Flow Cytometry - FC3200 (Calgary) Flow Cytometry Calgary

Microbiology Reference Organism & Specimen Investigation Request - MI-6123

Microbiology Calgary
Blood Component/Product Requisition-Neonatal/Pediatric - REQ9002TM Transfusion Medicine Calgary
Pretransfusion Testing Requisition - REQ9004TM Transfusion Medicine Calgary
Blood Component/Product Requisition - Adult - REQ9006TM Transfusion Medicine Calgary
Subcutaneous Immune Globulin Product Order and Home Use Dispense Requisition - REQ9008TM Transfusion Medicine Calgary
Post Natal Requisition - REQ9009TM Transfusion Medicine Calgary

Mobile Collection Service Requisition - 20884

Pre-Analytics Provincial Documents (all zones)
Bronchoalveloar Lavage/Bronchial Wash Requisition - REQ9024MI Cytology Calgary
Molecular Pathology Requisition - REQ9038AP Molecular Pathology Calgary

Non-Gynecological Cytopathology Requisition - REQ9041CY-NON

Cytology Calgary
Colposcopy Pathology Requisition - REQ9042COL Anatomic Pathology Calgary

Gynecological Cytopathology Requisition – 21815

Gynecological Cytopathology Requisition Completion Aid

Cytology Calgary
Histocompatibility and Immunogenetics (HIL) Requisition - REQ9054TT-HP (Bone Marrow Transplant) (Calgary) HIL Calgary
Outpatient Clinic General Laboratory and Microbiology Report to Clinic Completion Aid - CSD2712 Pre-Analytics Calgary
Outpatient Clinic General Laboratory Report to Physician Office Completion Aid - CSD2792 Pre-Analytics Calgary

Microbiology Requisition - REQ9021MI

Microbiology Calgary
Genotyping for Red Cell Antigens Requisition - REQ9007TM Transfusion Medicine Calgary
Preliminary Laboratory Testing for Directed Blood Donation - Intended Recipient - REQ9003TM Transfusion Medicine Calgary
Preliminary Laboratory Testing for Directed Blood Donation - Intended Donor - REQ9005TM Transfusion Medicine Calgary
Blood Component/Product Requisition - Rural - REQ9010TM Transfusion Medicine Calgary
Community General Requisition Completion Aid - CSD2714 Pre-Analytics Calgary
Electrocardiogram Requisition - REQ9015ECG Pre-Analytics Calgary
HIV Serology by Rapid Assay - REQ9016HIV Specialty Calgary
PADIS Medical Toxicology Clinic Requisition - REQ9016PADIS Toxicology Calgary
Community General Requisition Completion Aid - CSD2714 Pre-Analytics Calgary
Microbiology Infection Surveillance Requisition - 7828M Microbiology Calgary
Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition, Disease Association and Pharmacogenomics, HIL - REQ9054TT-DA (Calgary) HIL Calgary
Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition, Solid Organ Transplant, HIL - REQ9054TT-SO (Calgary) HIL Calgary
Bone Marrow Pathology Requisition, Marrow, BM - REQ9061BM Anatomical Pathology Calgary
Adrenal Venous Sampling Requisition For use by Diagnostic Imaging only - REQ9067AVS Specialty Calgary
First Trimester Combined Screen (FTS) Blood Work - REQ9080FTS (Calgary) Specialty Calgary
Urea Breath Test for Heliobacter pylori Laboratory Requisition - REQ9080UBT Pre-Analytics Calgary
Pretransfusion Testing Requisition PAC - TM2199 Transfusion Medicine Calgary
Ophthalmic Pathology Consultation Requisition - REQ9033AP Anatomical Pathology Calgary
Intra-Operative Neuropatholgoy Consultation - REQ9034AP Anatomical Pathology Calgary
Anatomic Pathology Placenta Requisition - REQ9036AP Anatomical Pathology Calgary
Cancer Cytogenetics - Chromosome & Fish Studies - REQ9037AP Genetics & Genomics Calgary
Request for Intra-operative Pathology Consultation - REQ9039AP Anatomical Pathology Calgary
Non Ultrasound Guided Fine Needle Aspiration Clinic Patient Referral form - REQ9044FNA Cytology Calgary
Essential Service Requisition - MOD Impact - REQ9051LTD Pre-Analytics Calgary
Molecular Hematology Requisition - REQ9053MH (Calgary DSC) Molecular Pathology Calgary
Flow Cytometry Out of Province Requisition - FC3200EP (Calgary) Flow Cytometry Calgary
Molecular Pathology Requisition - CH-1230 (North) Molecular Pathology Molecular Pathology
Essential Test Requisition - 21694 (For Use ONLY during Essential Test Menu Activation) - Provincial Documents (all zones)
COVID-19 and Other Respiratory Viruses Requisition 21701 COVID-19 Provincial Documents (all zones)
Semen Analysis Requisition - 20774 Hematology Provincial Documents (all zones)
Dermatopathology Requisition Anatomical Pathology Provincial Documents (all zones)
Infliximab Level Order - 20740 Chemistry Provincial Documents (all zones)
Tick Testing Request – 21813 (Cross-site) Public Health Provincial Laboratory for Public Health (ProvLab)
OncoType DX Requisition – 21809 Anatomical Pathology Provincial