Forms

• Specimen Collection Kit / Requisition Order Form

Requisitions

• Add On Test Fax Form (Cross-site)
• Bacteriology Culture and Serology Requisition CH-0039 (ProvLab North - Edmonton)
• Bacteriology Requisition – 20691 (ProvLab South – Calgary)
• Bone Marrow Transplant Testing Requisition (ProvLab South - Calgary)
• Malaria PCR Requisition (Cross-site)
• Reference Organism and Surveillance Requisition - 19193 (Cross-site)
• Serology and Molecular Testing Requisition (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)
• Zoonotic Serology Requisition (Cross-site)

Requisitions

• Routine Anatomical Pathology Consultation Request (Requisition)
  • Requisition Requirements - Anatomical Pathology
• Laboratory Services Vitamin D (25-Hydroxy)
  • Alberta Medical Association (AMA) and Alberta Health Services (AHS) Vitamin D Information Sheet

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

• Autopsy Consent and Consultation Request Form
• North Zone Laboratory Requisition
• Semen Analysis Requisition

Requisitions

• Add-On/Order Modification Laboratory Test Requisition
• Anatomical Pathology Requisition (Consultation Request)
• Chemistry Specialty Requisition
• Hematology Specialty Requisition
• Histocompatibility Requisition
• Nongynecologic Cytopathology Requisition
• Rapid HIV Antibody Test Request
• Routine Requisition
• Semen Analysis Requisition
• STAT Requisition
• Transfusion Medicine Requisition

Forms

• Autopsy Consent and Consultation Request Form
• Lamotrigine Therapeutic Drug Monitoring (TDM) Guideline
• Lamotrigine Level Order Form
• Client Supply Order – Provincial Form
• Client Supply Order – Edmonton Form
• Edmonton Zone Immunohistochemistry Request Form

Requisitions & Forms

• Semen Analysis Requisition
• Central Zone Laboratory Requisition
• Spinal Fluid Collection Protocol
• Central Zone Non-Gynecological Requisition
• Consent for Autopsy
  • Adult Autopsies Infosheet
  • Requesting Pediatric-Stillborn Autopsies from Red Deer Hospital - Central and North Zone

• Calgary Laboratory Services Forms and Requisitions

The Laboratory offers a variety of Lab Forms which can be ordered directly from Stores Dept:

Requisitions

• South Zone Laboratory and Microbiology Requisition FAQs
• Laboratory Requisition
• Microbiology Requisition
• Semen Analysis Requisition

Forms

• Medicine Hat Laboratory Supply Request Form