Forms

• Specimen Collection Kit / Requisition Order Form

Requisitions

• Add On Test Fax Form - 20721 (Cross-site)
• Bacteriology Culture and Serology Requisition CH-0039 (ProvLab North - Edmonton)
• Bacteriology Requisition - 20691 (ProvLab South - Calgary)
• Blood and 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)
• Prenatal Testing Requisition - 21151 (Cross-site)
• 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)
• 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
• Laboratory Add-on/Order Modification Requisition - CH-0679
• Blood and Body Fluid Exposure - 21150 (Cross-site)
• Semen Analysis Requisition
• Routine Anatomical Pathology Consultation Request (Requisition)
  • Requisition Requirements - Anatomical Pathology
• Autopsy Consent and Consultation Request
• 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

Forms

• Client Supply Order – Provincial Form
• 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

• COVID-19 Test Requisition Form
• Microbiology Requisition – 20571
• Transfusion Medicine – 21448

Requisitions

• Laboratory Add-on/Order Modification Requisition is now found under the Provincial Documents (All Zones)
• Anatomical Pathology Requisition (Consultation Request)
• Chemistry Specialty Requisition
• COVID-19 Test Requisition Form
• Hematology Specialty Requisition
• Histocompatibility Requisition
• Maternal Prenatal Screen Requisition (Edmonton & area)
• Microbiology Requisition – 20571
• Nongynecologic Cytopathology Requisition
• Rapid HIV Antibody Test Request
• STAT Requisition
• Transfusion Medicine Requisition

Forms

• Client Supply Order – Provincial Form
• Client Supply Order – Edmonton Form
• Edmonton Zone Immunohistochemistry Request Form

Requisitions & Forms

• Central Zone Non-Gynecological Requisition
  • Adult Autopsies Infosheet
  • Requesting Pediatric-Stillborn Autopsies from Red Deer Hospital - Central and North Zone
• COVID-19 Test Requisition Form
• Microbiology Requisition – 20571
• Spinal Fluid Collection Protocol
• Transfusion Medicine – 21448

• Alberta Precision Labs
• COVID-19 Test Requisition Form

Requisitions

• COVID-19 Test Requisition Form
• Microbiology Requisition – 20571
• Non-Gynecological Cytology Requisition
• Transfusion Medicine – 21448
• Bone Marrow Request FC-1017 - Chinook Regional Hospital Lethbridge

Forms

• Medicine Hat Laboratory Supply Request Form