Requisitions

Requisition Name or Number Discipline Zone
COVID-19 Test Requisition Form COVID-19 North
Microbiology Requisition – 20571 Microbiology North
Transfusion Medicine – 21448 Transfusion Medicine North
Semen Analysis Requisition Specialty North
Add-On/Order Modification Laboratory Test Requisition Pre-Analytics Edmonton
Chemistry Specialty Requisition Chemistry Edmonton
COVID-19 Test Requisition Form COVID-19 Edmonton
Hematology Specialty Requisition Hematology Edmonton
Histocompatibility Requisition Histocompatibility Edmonton
Maternal Prenatal Screen Requisition (Edmonton & area) - Edmonton
Microbiology Requisition – 20571 Microbiology Edmonton
EZ Nongyecologic Cytopathology Requisition Cytopathology Edmonton
Rapid HIV Antibody Test Request - Edmonton
Semen Analysis Requisition - Edmonton
STAT Requisition Pre-Analytics Edmonton
Transfusion Medicine – 21448 Transfusion Medicine Edmonton

Lamotrigine Level Order Form

Lamotrigine Level Order Form Completion Aid

Toxicology Edmonton
Edmonton Zone Immunohistochemistry Request Form Anatomical Pathology Edmonton
CZ Nongyecologic Cytopathology Requisition 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 COVID-19 Central
Microbiology Requisition – 20571 Microbiology Central
Semen Analysis Requisition - Central
Spinal Fluid Collection Protocol Pre-Analytics Central
Transfusion Medicine – 21448 Transfusion Medicine Central
COVID-19 Test Requisition Form COVID-19 Calgary
COVID-19 Test Requisition Form COVID-19 South
Microbiology Requisition – 20571 Microbiology South
SZ Nongyecologic Cytopathology Requisition Cytology South
FC-1017 Bone Marrow Request - Chinook Regional Hospital Lethbridge Hematology South
Semen Analysis Requisition - 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 (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

Laboratory Requisition Completion Aid

Pre-Analytics Provincial Documents (all zones)
Blood and Body Fluid Exposure - 21150 (Cross-site) Pre-Analytics Provincial Documents (all zones)
Routine Anatomical Pathology Consultation Request (Requisition) Anatomic Pathology Provincial Documents (all zones)
Requisition Requirements - Anatomical Pathology Anatomic Pathology Provincial Documents (all zones)
Autopsy Consent and Consultation Request Anatomic Pathology Provincial Documents (all zones)

Laboratory Services Vitamin D (25-Hydroxy) Alberta Medical Association (AMA)

Alberta Medical Association (AMA) and Alberta Health Services (AHS) Vitamin D Information Sheet

Chemistry Provincial Documents (all zones)
Biochemical Genetics Laboratory Requisition (Calgary Laboratory) Genetics/Genomics Biochemical Genetics Laboratory/Newborn Metabolic Screening
Chemistry Specialty Requisition (Edmonton Laboratory) Genetics/Genomics Biochemical Genetics Laboratory/Newborn Metabolic Screening
Maternal Prenatal Screen Requisition (Edmonton & area) Genetics/Genomics Biochemical Genetics Laboratory/Newborn Metabolic Screening
Constitutional Cytogenetics Requisition (North and South) Genetics/Genomics Cytogenetics Laboratory
Hematology Specialty Requisition (Edmonton Laboratory) Genetics/Genomics Cytogenetics Laboratory
Chromosomal Microarray (CMA) Requisition (North and South) Genetics/Genomics Cytogenetics Laboratory
Molecular Diagnostic Laboratory Requisition (Calgary Laboratory) Genetics/Genomics Molecular Genetics Laboratory
Molecular Diagnostic Laboratory Requisition (Edmonton Laboratory) Genetics/Genomics Molecular Genetics Laboratory
Cancer and Endocrine Next Generation Sequencing Requisition (Provincial Requisition) Genetics/Genomics Molecular Genetics Laboratory
Molecular Pathology Requisition Molecular Pathology Molecular Pathology
Flow cytometry-Calgary Flow Cytometry Calgary

Microbiology Reference Organism & Specimen Investigation Request

Microbiology Reference Organism & Specimen Investigation Request Completion Aid

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

Mobile Collection Service Requisition

Mobile Collection Service Requisition Completion Aid

Pre-Analytics Calgary
HIV Viral Load Requisition Specialty Calgary
Bronchoalveloar Lavage/Bronchial Wash Requisition Cytology Calgary
Molecular Pathology Requisition Molecular Pathology Calgary

Non-Gynecological Cytopathology Requisition

Non-Gynecological Cytopathology Requisition Completion Aid

Cytology Calgary
Colposcopy Pathology Requisition Anatomic Pathology Calgary

Gynecological Cytopathology Requisition

Gynecological Cytopathology Requisition Completion Aid

Cytology Calgary
Calgary Histocompatibility and Immunogenetics (HIL) Requisition - REQ9054TT-HP (Bone Marrow Transplant) HIL Calgary
Outpatient Clinic General Laboratory and Microbiology Report to Clinic Completion Aid Pre-Analytics Calgary
Community Anatomical Pathology Completion Aid Pre-Analytics Calgary
Acute Care Anatomical Pathology Completion Aid Pre-Analytics Calgary
Outpatient Clinic General Laboratory Report to Physician Office Completion Aid Pre-Analytics Calgary
Microbiology Requisition Requirements: Chlamydia trachomatis/Neisseria gonorrhoeae/Trichomonas vaginalis Testing Completion Aid Microbiology Calgary
Genotyping for Red Cell Antigens Requisition Transfusion Medicine Calgary
Preliminary Laboratory Testing for Directed Blood Donation - Intended Recipient Transfusion Medicine Calgary
Preliminary Laboratory Testing for Directed Blood Donation - Intended Donor Transfusion Medicine Calgary
Blood Component/Product Requisition-Rural Transfusion Medicine Calgary
Community General Requisition Completion Aid Pre-Analytics Calgary
Electrocardiogram Requisition Pre-Analytics Calgary
HIV Serology by Rapid Assay Specialty Calgary
PADIS Medical Toxicology Clinic Requisition Toxicology Calgary
Microbiology Requisition Microbiology Calgary
Community General Requisition Completion Aid Pre-Analytics Calgary
Microbiology Infection Surveillance Requisition Microbiology Calgary
Community Requisition for Long Term Care and Supportive Living Completion Aid Pre-Analytics Calgary
Requisition Requirements Community Microbiology Completion Aid Pre-Analytics Calgary
Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition, Disease Association and Pharmacogenomics, HIL HIL Calgary
Histocompatibility and Immunogenetics (HIL)/Tissue Typing Requisition, Solid Organ Transplant, HIL HIL Calgary
Bone Marrow Pathology Requisition, Marrow, BM Anatomical Pathology Calgary
Adrenal Venous Sampling Requisition For use by Diagnostic Imaging only Specialty Calgary
First Trimester Combined Screen (FTS) Blood Work Specialty Calgary
Urea Breath Test for Heliobacter pyloi Laboratory Requisition Pre-Analytics Calgary
Pretransfusion Testing Requisition PAC Transfusion Medicine Calgary
Ophthalmic Pathology Consultation Requisition Anatomical Pathology Calgary
Intra-Operative Neuropatholgoy Consultation Anatomical Pathology Calgary
Dermatopatholgoy Consult Test Request Form Anatomical Pathology Calgary
Anatomic Pathology Placenta Requisition Anatomical Pathology Calgary
Cancer Cytogenetics-Chromosome & Fish Studies Genetics & Genomics Calgary
Request for Intra-operative Pathology Consultation Anatomical Pathology Calgary
Non Ultrasound Guided Fine Needle Aspiration Clinic Patient Referral form Cytology Calgary
Essential Service Requisition-MOD Impact Pre-Analytics Calgary
Molecular Hematology Requisition Molecular Pathology Calgary
Flow Cytometry Out of Province Requisition-FC3200EP Flow Cytometry Calgary