Forms

• Environmental Waters Specimen Collection Kit / Requisition Order Form
• Specimen Collection Kit/Requisition Order Form

Requisitions

• Add On Test Fax Form - 20721 (Cross-site)
• Public Health Microbiology Requisition - 20691 (Cross-site)
• Blood & Body Fluid Exposure - 21150 (Cross-site)
• Bone Marrow Transplant Testing Requisition - 19581 (ProvLab South - Calgary)
• Deceased Organ Donor Requisition - 20116 (Cross-site)
• Living Donor Infectious Disease Screening Requisition (Cross-site)
• Malaria PCR Requisition - 20722 (Cross-site)
• Microbiological Water Analysis Requisition – 190162 (Cross-site)
  • Requisitions not available for print, a copy may be obtained from Environmental Public Health agencies or Public Health Laboratory (Distribution)
• Prenatal Testing Requisition - 21151 (Cross-site)
• QuantiFERON TB Testing - 21996
• Rapid HIV Antibody Requisition - 21636
• Reference Organism and Surveillance Requisition - 19193 (Cross-site)
• Serology and Molecular Testing Requisition - 20676 (Cross-site)
• Solid Organ Transplant (ADULT) Recipient Screening - 20970 (Cross-site)
• Solid Organ Transplant (PEDIATRIC) Recipient Screening - 20971 (Cross-site)
• Solid Organ Post Transplant Follow Up - 20972 (Cross-site)
• STI Test Requisition 19914
• Tissue and Bone Marrow Transplant Donor Testing Requisition - 21278 (Cross-site)
• Zoonotic Serology Requisition - 20087 (Cross-site)

Requisitions

• Laboratory Requisition Completion Aid 
• General Laboratory Requisition – 21302
• Microbiology Requisition – 20571
• Connect Care Downtime General Laboratory Requisition – 21647
• Connect Care Downtime Microbiology Requisition – 22176
• Laboratory Add-on/Order Modification Requisition – CH-0679
• Blood and Body Fluid Exposure – 21150 (Cross-site)
• Semen Analysis Requisition
• Anatomical Pathology Consultation Request (Requisition)
  • Anatomical Pathology Request Completion Aid
• Autopsy Consent and Consultation Request
• Dermatopathology Requisition
• Immunohistochemistry Requisition
• Non-Gynecological Cytopathology Requisition – 22204
• Transfusion Medicine – 21448
• Laboratory Services Vitamin D (25-Hydroxy)
  • Alberta Medical Association (AMA) and Alberta Health Services (AHS) Vitamin D Information Sheet
• COVID-19 and Other Respiratory Viruses Requisition – 21701
• Rapid HIV Antibody Requisition – 21636
• Antiphospholipid Syndrome Investigation Requisition – 22071
• Special Coagulation Testing Requisition Hemostasis Investigations – 21905
• Special Coagulation Testing Requisition Hereditary Thrombosis – 21911
• Second Trimester Prenatal Risk Assessment Requisition – 21908
• Bone Marrow Pathology Requisition - 22230

Forms

• Hemoglobin A1c (HbA1c) Patient Letter
• D-Dimer Pre-Test Probability Assessment for Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE) Score Card for Clinicians
• FIT Patient Letter
• Lab Formulary Intake Request Form

• Genetics Forms and Requisitions

Requisitions & Forms

• First Trimester Prenatal Risk Assessment Requisition - 21909

Requisitions

• Laboratory Add-on/Order Modification Requisition is now found under the Provincial Documents (All Zones)
• Chemistry Specialty Requisition
• Histocompatibility Requisition
• Transfusion Medicine Requisition
• First Trimester Prenatal Risk Assessment Requisition - 21909

Requisitions & Forms

• Requesting Pediatric-Stillborn Autopsies from Red Deer Hospital - Central and North Zone
• First Trimester Prenatal Risk Assessment Requisition - 21909

• Alberta Precision Labs Requisitions

Requisitions

• Bone Marrow Request FC-1017 - Chinook Regional Hospital Lethbridge