Laboratory Requisitions

A

Adverse/Reaction Event Form (2021) [PDF]

B

Blood Transfusion Service Request Form (2021) [PDF]

C

CPOE Pathology Orders Form (2021) [PDF]

Cytology and HPV Request Form (2023) [PDF]

F

Flow Cytometry Request Form (2020) [PDF]

H

Health PEI Provincial Lab Services Practitioner Change Form (2021) [PDF]

I

INR Point of Care (POC) Confirmation Form (2021) [PDF]

IVIG - Dermatology (Adult and Pediatric) Request Form (2023) [PDF]

IVIG - Emergency Release Form (2023) [PDF]

IVIG - Hematology (Adult) Request Form (2023) [PDF]

IVIG - Hematology (Pediatric) Request Form (2023) [PDF]

IVIG - Immunology (Adult and Pediatric) Request Form (2023) [PDF]

IVIG - Infectious Disease (Adult and Pediatric) Request Form (2023) [PDF]

IVIG - Neurology (Adult and Pediatric) Request Form (2023) [PDF]

IVIG - Rheumatology (Adult and Pediatric) Request Form (2023) [PDF]

IVIG - Solid Organ Transplant Request Form (2023) [PDF]

IVIG - Subcutaneous Immunoglobulin (SCIG) Request Form (2023) [PDF]

L

Laboratory Blood Test Request Form (2021) [PDF]

M

Microbiology Blood Requisition Form (serology) (2021) [PDF]

Microbiology Request Form (2021) [PDF]

N

Novel Coronavirus 2020 v10 Dec 21 2020 PDF

P

Physician/NP Field on Laboratory Requisitions [PDF]

POCT Request Form (2021) [PDF]

Post-Mortem Test Request Form (2021) [PDF]

R

Reaction/Adverse Event Form (2019) [PDF]

Request for Hemlibra, Panhematin, Eloctate, Alprolix or Jivi (2020) [PDF]

S

Serum Allergy Test Request Form (2021) [PDF]

Storage Requirements for Hematology Samples Prior/During Transport to QEH Laboratory [PDF]

Surgical Pathology and Bone Marrow Request Form (2021) [PDF]

Surgical Pathology Frozen Section:  Intra-Operative Consultation Report (2021) [PDF]

U

Urine, Body Fluids and CSF Test Request Form (2021) [PDF]

Urine Drug Screen Confirmatory Testing Form (2021) [PDF]

Last Updated
Fri, 11/17/2023 - 11:06