Requisitions
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
- Microbiology Requisition
- Anatomical Pathology Consultation Request
- Gynecological Cytopathology Requisition
- Dermatopathology Requisition
- IgE Allergy Testing Requisition
- Mobile Collections Requisition
- Semen Analysis Requisition
- Urea Breath Test for Helicobacter Pylori Laboratory Requisition
Full List of Requisitions
| Requisition Name or Number | Discipline | Keywords | Zone |
|---|---|---|---|
| Pre-Analytics | - | Provincial Documents (all zones) | |
| Canadian Blood Services (CBS) Requisitions (Perinatal Testing) | Transfusion Medicine | - | Provincial Documents (all zones) |
| IgE Allergy Testing Requisition - 22106 | Pre-Analytics | - | Provincial Documents (all zones) |
| Urea Breath Test for Helicobacter Pylori Laboratory Requisition - 22107 | Pre-Analytics | - | Provincial Documents (all zones) |
| Mobile Collections Requisition - 22108 | Pre-Analytics | - | Provincial Documents (all zones) |
| First Trimester Prenatal Risk Assessment Requisition - 21909 | Chemistry | Chemistry, Chemistry Specialty | Central, Edmonton, North |
| Microbiology | Micro, Microbiology, Info sheet, North | Provincial Documents (all zones) | |
| Laboratory Add-on/Order Modification Requisition – CH-0679 | Pre-Analytics | Add, Add-On/Order Modification Laboratory Test | Provincial Documents (all zones) |
| Chemistry Specialty Requisition - CH-0311 | Chemistry | Chemistry, Chemistry Specialty | Edmonton |
| Hematology Specialty Requisition - CH-0312 | Hematology | Hematology, Hematology Specialty | Edmonton |
| Histocompatibility Requisition - CH-0319 (Edmonton) | Histocompatibility | Histocompatibility, Histocompatibility | Edmonton |
| Nongynecologic Cytopathology Requisition - 20984 | Cytopathology | Nongynecologic, Nongynecologic Cytopathology | Edmonton |
| Immunohistochemistry Requisition | Anatomical Pathology | Immunohistochemistry Requisition | Provincial Documents (all zones) |
| Nongynecologic Cytopathology Requisition - 20444 | Cytology | Central, Central Zone Non-Gynecological, Cytology | Central |
| Requesting Pediatric-Stillborn Autopsies from Red Deer Hospital - Central and North Zone Completion Aid | Anatomical Pathology | Pediatric-Stillborn Autopsies, Red Deer Hospital, Central, North, Completion Aid | Central |
| Nongynecologic Cytopathology Requisition - 101945 | Cytology | South, South Zone Non-Gynecological, Cytology | South |
| Bone Marrow Request - FC-1017 (Chinook Regional Hospital Lethbridge) | Hematology | South, Hematology, Bone Marrow Request, CRH | South |
| Specimen Collection Kit / Requisition Order Form | Public Health | Specimen Collection Kit / Requisition Order | Provincial Laboratory for Public Health (ProvLab) |
| Add On Test Fax Form - 20721 (Cross-site) | Public Health | Add, Add On Test Fax Form - 20721 (Cross | Provincial Laboratory for Public Health (ProvLab) |
| Bacteriology Requisition -20691 (Cross-site) | Public Health | Bacteriology, Bacteriology Requisition, 20691, ProvLab | Provincial Laboratory for Public Health (ProvLab) |
| Blood and Body Fluid Exposure - 21150 (Cross-site) | Public Health | Blood, Blood and Body Fluid Exposure, 21150 | Provincial Laboratory for Public Health (ProvLab) |
| Bone Marrow Transplant Testing Requisition - 19581 (ProvLab South - Calgary) | Public Health | Bone, Bone Marrow Transplant Testing Requisition, 19581, ProvLab South | Provincial Laboratory for Public Health (ProvLab) |
| Deceased Organ Donor Requisition - 20116 (Cross-site) | Public Health | Deceased, Deceased Organ Donor Requisition, 20116 | Provincial Laboratory for Public Health (ProvLab) |
| Living Donor Infectious Disease Screening Requisition - 20829 (Cross-site) | Public Health | Living, Living Donor Infectious Disease Screening Requisition | Provincial Laboratory for Public Health (ProvLab) |
| Malaria PCR Requisition - 20722 (Cross-site) | Public Health | Malaria, Malaria PCR Requisition, 20722 | Provincial Laboratory for Public Health (ProvLab) |
| Prenatal Testing Requisition - 21151 (Cross-site) | Public Health | Prenatal, Prenatal Testing Requisition, 21151 | Provincial Laboratory for Public Health (ProvLab) |
| Reference Organism and Surveillance Requisition - 19193 (Cross-site) | Public Health | Reference, Reference Organism and Surveillance Requisition, 19193 | Provincial Laboratory for Public Health (ProvLab) |
| Serology and Molecular Testing Requisition - 20676 (Cross-site) | Public Health | Serology, Serology and Molecular Testing Requisition, 20676 | Provincial Laboratory for Public Health (ProvLab) |
| Solid Organ Transplant (ADULT) Recipient Screening - 20970 (Cross-site) | Public Health | Solid, Solid Organ Transplant (ADULT) Recipient Screening, 20970 | Provincial Laboratory for Public Health (ProvLab) |
| Solid Organ Transplant (PEDIATRIC) Recipient Screening - 20971 (Cross-site) | Public Health | Solid, Solid Organ Transplant (PEDIATRIC) Recipient Screening, 20971 | Provincial Laboratory for Public Health (ProvLab) |
| Solid Organ Post Transplant Follow Up - 20972 (Cross-site) | Public Health | Solid, Solid Organ Post Transplant Follow Up, 20972 | Provincial Laboratory for Public Health (ProvLab) |
| Tissue and Bone Marrow Transplant Donor Testing Requisition - 21278 (Cross-site) | Public Health | Tissue, Tissue and Bone Marrow Transplant Donor Testing Requisition, 21278 | Provincial Laboratory for Public Health (ProvLab) |
| Zoonotic Serology Requisition - 20087 (Cross-site) | Public Health | Zoonotic, Zoonotic Serology Requisition, 20087 | Provincial Laboratory for Public Health (ProvLab) |
| Pre-Analytics | General, General Laboratory | Provincial Documents (all zones) | |
| Blood and Body Fluid Exposure - 21150 (Cross-site) | Pre-Analytics | Blood, Blood and Body Fluid Exposure, 21150 | Provincial Documents (all zones) |
| Anatomic Pathology | Routine Anatomical Pathology Consultation Request, AP | Provincial Documents (all zones) | |
| Autopsy Consent and Consultation Request - 20597 | Anatomic Pathology | Autopsy, Autopsy Consent and Consultation, AP | Provincial Documents (all zones) |
| Chemistry | Laboratory, Laboratory Services Vitamin D, VitD, 19500 | Provincial Documents (all zones) | |
| Biochemical Genetics Laboratory Requisition - 18521 | Genetics/Genomics | Biochemical, Biochemical Genetics Laboratory Requisition, Calgary zone | Biochemical Genetics Laboratory/Newborn Metabolic Screening |
| Hematology Specialty Requisition - CH-0312 (Edmonton Laboratory) | Genetics/Genomics | Hematology, Hematology Specialty Requisition (Edmonton | Cytogenetics Laboratory |
| Cancer and Endocrine Next Generation Sequencing Requisition - 20897 (Provincial Requisition) | Genetics/Genomics | Cancer, Cancer and Endocrine Next Generation Sequencing Requisition (Provincial | Molecular Genetics Laboratory |
| Molecular Pathology Requisition - CH-1230 | Molecular Pathology | Molecular, Molecular Pathology | Molecular Pathology |
| Flow Cytometry - FC3200 (Calgary) | Flow Cytometry | Flow, Flow cytometry | Calgary |
| Subcutaneous Immune Globulin Product Order and Home Use Dispense Requisition - REQ9008TM | Transfusion Medicine | Transfusion, Subcutaneous Immune Globulin Product Order and Home Use Dispense Requisition, Transfusion Medicine, TM | Calgary |
| Molecular Pathology Requisition - REQ9038AP | Molecular Pathology | Molecular, Molecular Pathology Requisition | Calgary |
| Cytology | Cytology, Non-Gyne, Non-Gyne cyto | Calgary | |
| Colposcopy Pathology Requisition - REQ9042COL | Anatomic Pathology | Anatomic, Colposcopy Pathology Requisition, AP | Calgary |
| Cytology | Cytology, Gynecological Cytopathology Requisition | Calgary | |
| Histocompatibility and Immunogenetics (HIL) Requisition - REQ9054TT-HP (Bone Marrow Transplant) (Calgary) | HIL | HIL, Calgary Histocompatibility and Immunogenetics (HIL) Requisition | Calgary |
| PADIS Medical Toxicology Clinic Requisition - REQ9016PADIS | Toxicology | Toxicology, PADIS Medical Toxicology Clinic Requisition | Calgary |
| Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition, Disease Association and Pharmacogenomics, HIL - REQ9054TT-DA (Calgary) | HIL | HIL, Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition Disease Association and Pharmacogenomics | Calgary |
| Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition, Solid Organ Transplant, HIL - REQ9054TT-SO (Calgary) | HIL | HIL, Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition Solid Organ Transplant | Calgary |
| Bone Marrow Pathology Requisition, Marrow, BM - REQ9061BM | Anatomical Pathology | Anatomical, Bone Marrow Pathology Requisition | Calgary |
| First Trimester Combined Screen (FTS) Blood Work - REQ9080FTS (Calgary) | Specialty | First Trimester, FTS, Blood Work | Calgary |
| Ophthalmic Pathology Consultation Requisition - REQ9033AP | Anatomical Pathology | Anatomical, Ophthalmic Pathology Consultation Requisition, AP | Calgary |
| Anatomic Pathology Placenta Requisition - REQ9036AP | Anatomical Pathology | Anatomical, Anatomic Pathology Placenta Requisition, AP, Placenta | Calgary |
| Cancer Cytogenetics - Chromosome & Fish Studies - REQ9037AP | Genetics & Genomics | Cancer Cytogenetics, Fish Studies, Chromosome | Calgary |
| Request for Intra-operative Pathology Consultation - REQ9039AP | Anatomical Pathology | Anatomical, Request for Intra-Op, AP Consult, AP, Anatomical Pathology | Calgary |
| Non Ultrasound Guided Fine Needle Aspiration Clinic Patient Referral form - REQ9044FNA | Cytology | Cytology, Non Ultrasound Guided Fine Needle Aspiration Clinic Patient Referral form, Non-US FNA, FNA | Calgary |
| Molecular Hematology Requisition - REQ9053MH (Calgary DSC) | Molecular Pathology | Molecular, Molecular Hematology Requisition | Calgary |
| Flow Cytometry Out of Province Requisition - FC3200EP (Calgary) | Flow Cytometry | Flow Cytometery; Out-of-Province; FC200EP; Calgary | Calgary |
| Molecular Pathology Requisition - CH-1230 (North) | Molecular Pathology | Molecular, Molecular Pathology, North, 1230 | Molecular Pathology |
| Essential Test Requisition - 21604 (For Use ONLY during Essential Test Menu Activation) | - | General, General Laboratory | Provincial Documents (all zones) |
| COVID-19 and Other Respiratory Viruses Requisition 21701 | COVID-19 | COVID-19, Respiratory Viruses | Provincial Documents (all zones) |
| Semen Analysis Requisition - 20774 | Hematology | Semen, Semen Analysis | Provincial Documents (all zones) |
| Dermatopathology Requisition | Anatomical Pathology | Dermatopathology | Provincial Documents (all zones) |
| Infliximab Level Order - 20740 | Chemistry | Gastro | Provincial Documents (all zones) |
|
Clinical Tick/Arthropod Submission – Microbiology Requisition – 20571
|
Public Health | Tick | Provincial Laboratory for Public Health (ProvLab) |
| OncoType DX Requisition – 21809 | Anatomical Pathology | OncoType DX | Provincial |
|
Connect Care Downtime General Laboratory Requisition - 21647 |
Pre-Analytics | - | Provincial Documents (all zones) |
| Transfusion Medicine – 21448 | Transfusion Medicine | Transfusion Medicine, Transfusion | Provincial Documents (all zones) |
| Cytogenetic Analysis, Constitutional Requisition 21890 (North & South) | Genetics/Genomics | - | Cytogenetics Laboratory |
| Special Coagulation Testing Requisition Hemostasis Investigations – 21905 | Coagulation | - | Provincial Documents (all zones) |
| Special Coagulation Testing Requisition Thrombosis – 21911 | Coagulation | - | Provincial Documents (all zones) |
| QuantiFERON TB Testing - 21996 | Public Health | TB, QuantiFERON, 21996 | Provincial Laboratory for Public Health (ProvLab) |
| Rapid HIV Antibody Requisition - 21636 | Public Health | Rapid, Rapid HIV Antibody Test | Provincial Laboratory for Public Health (ProvLab) |
| Molecular Genetics Laboratory General Requisition | Genetics/Genomics | Molecular, Molecular Diagnostic Laboratory Requisition | Molecular Genetics Laboratory |
| Cardiac, Connective Tissue & Vascular Next Generation Sequencing Requisition | Genetics/Genomics | Cardiac, Connective Tissue, Vascular, Sequencing Requisition | Molecular Genetics Laboratory |
| STI Test Requisition - 19914 | Public Health | STI, Test | Provincial Laboratory for Public Health (ProvLab) |
| Antiphospholipid Syndrome Investigation Requisition - 22071 | Coagulation | - | Provincial Documents (all zones) |
| Second Trimester Prenatal Risk Assessment Requisition - 21908 | Chemistry | - | Provincial Documents (all zones) |
| Ophthalmology Microbiology Requisition – 22153 | Microbiology | - | Provincial Documents (all zones) |