Laboratory Requisitions

A

Adverse/Reaction Event Form (2021) [PDF]

B

Blood Transfusion Service Request Form (2021) [PDF]

C

COVID-19 Virus Request Form ( 2021) [PDF]

CPOE Pathology Orders Form (2021) [PDF]

Cytology Request Request Form (2021) [PDF]

F

Flow Cytometry Request Form (2020) [PDF]

H

HPV Testing Request Form (2021) [PDF]

I

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

IVIG - Dermatology (Adult and Pediatric) Request Form (2018) [PDF]

IVIG - Emergency Release Form (2018) [PDF]

IVIG - Hematology (Adult) Request Form (2018) [PDF]

IVIG - Hematology (Pediatric) Request Form (2018) [PDF]

IVIG -Immunology (Adult and Pediatric) Request Form (2018) [PDF]

IVIG - Infectious Disease (Adult and Pediatric) Request Form (2018) [PDF]

IVIG - Neurology (Adult and Pediatric) Request Form (2018) [PDF]

IVIG - Rheumatology (Adult and Pediatric) Request Form (2018) [PDF]

IVIG - Solid Organ Transplant Request Form (2018) [PDF]

IVIG - Subcutaneous Immunoglobulin (SCIG) Request Form (2021) [PDF]

L

Laboratory Blood Test Request Form (2021) [PDF]

M

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

Microbiology Request Form (2021) [PDF]

P

Physician/NP Field on Laboratory Requisitions [PDF]

POCT Request Form [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]

T

Tick Identification Request Form (2021) [PDF]

U

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

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

Last Updated
Thu, 08/12/2021 - 09:45