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Biochemistry
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ACTH (Cosyntropin) STIMULATION (regular dose)
Adrenal Vein Sampling Requisition (R250-10-59)
Approval for Test Referral Biochemistry (F260-11-02)
Approval for Test Referral Immunology and Hematology F150-100-100
Arginine Stimulation
BTHC Delphic Requisition (R250-10-70)
Baylor (BCM) Requisition (See pages 1, 3 & 7)
Biochemical Genetics Laboratory Requisition (R250-10-69)
BloodCenter of WI Platelet & Neutrophil Immunology Lab Requisition
Body Fluid Chemistry Requisition (R250-10-53)
Bone Marrow Requisition (Hematology Services) (R250-10-27)
Bone Marrow Requisition (R250-10-86)
Bone Marrow Review / Consult Request
CM077 Fax Notification (F160-INV-32)
COVID-19 Specific Requisition (R250-10-89)
CS9248 Test Requisition (Stanford)
Cadham
Cadham HIV Requisition
Cervical Cytology Request Form
Cervical Cytology Request Form SBH/Bethesda
Cincinnati Children's Hospital Immunology Test Requisition
Cincinnati Children's Hospital Molecular Genetics Test Requisition
Cirion Lab Requisition (supplied with kit)
Clinical Microbiology - HSC Lab Test Requisition (R250-10-06)
Clinical Microbiology - SBH Lab Test Requisition (R250-10-07)
Clinical Microbiology - Westman Lab Test Requisition R250-10-08 V01
Clonidine Stimulation
Cytogenetic & FISH – Constitutional requisition (R250-10-71)
Cytogenetics & FISH - Prenatal Requisition (R250-10-73)
Cytogenetics & FISH Hematology/Oncology Requistion (R250-10-72)
Cytogenetics & FISH Tissues Requisiton (R250-10-74)
Cytogentics Oncology Requisition (R250-10-72)
Dauphin Downtime Hematology Requisition F100-120-0105 V02
DeSalaberry Health Centre Lab Requisition (R250-10-04)
Drug Screen Consultation Requisition (R250-10-24)
Emergency Urgent Care Laboratory Requisition (R250-10-88)
FISH Panel - Mayo Clinic
Flin Flon Chemistry & Hematology Requisition (R250-10-58)
Flow Cytometry Laboratory Requisition (R250-10-82)
Flow Cytometry Requisition (Calgary) FC3200
GD Specialized Diagnostics Requisition
Gastrin Secretin Stimulation Test
Gillam Hospital Lab Requisition F100-80-09 V02
Glucagon Stimulation
Glucose GH Suppression
GnRH Stimulation Female
GnRH Stimulation Male
Grace Hospital (GH) - On Site Requisition (R250-10-11)
Growth Hormone Sleep Study
HIT Screen - Heparin Induced Thrombocytopenia Screening Requisition (R250-10-81)
HSC Biochemistry Potassium (Hyperkalemia) Test Requisition (R250-10-01)
HSC Chemistry, Hematopathology - Miscellaneous (fluids) Test Requisition
HSC Chemistry, Hematopathology Test Requisition - Blood, Serum, Plasma
HSC Molecular Diagnostic Hereditary Cancer Test Requisition (R250-10-10)
HSC Molecular Diagnostic Lab - Molecular Pathology Test Requisition (R250-10-03)
HSC Molecular Diagnostic Lab Test Requistion (R250-10-09)
HSC Molecular Hematopathology, R250-10-29
Haemostasis Test Requisition (R250-10-12)
Hamilton Health Sciences Molecular Diagnostic Genetics Requisition
Hemoglobinopathy Investigation Requisition (R250-10-78)
Hemostatsis Consult F140-80-48A
Hereditary Cancer Molecular Requisition (R250-10-10)
I-Stat Requisition - Report (F110-10-04A V05)
IERHA Downtime Request and Report (R250-10-15)
IERHA General Laboratory Requisition (R250-10-13)
IERHA Urinalysis Request and Report (R250-10-14)
IV Busulfex Pharmacokinetics Requisition
IVIG SCIG Physician Form (Follow Up) (R250-10-68)
IVIG SCIG Physician Form (Initial Treatment) (R250-10-67)
Immunology Autoimmune Laboratory Requisition (R250-10-85)
Immunology Test Requisition (R250-10-21)
Insulin Stimulation
L-Dopa Propanolol Stimulation
LabPMM - Molecular
Leaf Rapids Lab Requisition F100-100-1012 V02
Mayo Hematopathology/ Cytogenetics Test Requsition
Miscellaneous Test Report (Rural) F100-20-1100 V08
Mitogen Advanced Diagnostics Laboratory - Autoantibody Test Req
Molecular Diagnostic Lab (R250-10-09)
Molecular Genetic BC Cancer/PHSA Labs Requisition
Morris Laboratory Request Form F100-110-38 V03
Mount Sinai Cytogenetics Requisition and Consent Form
Neuroimmunology Labs Requisition
Non-Gynaecological Cytology Requisition - HSC (2 pages) R250-10-30 V01
Non-Gynaecological Cytology Requisition - SBH (2 pages) R250-10-31 V01
Non-Gynaecological Cytology Requisition - SBH/Bethesda R250-10-32 V01
Non-Gynaecological Cytology Requisition - WL R250-10-34 V01
Pathology Lab Test Requisition (Form #BRH 012) - Westman Lab
Pathology Services - Westman Lab Test Requisition BRH 11 (R250-10-50)
Pathology Services HSC Laboratory Requisition (80993)
Pathology Services Histology Breast Requisition - Excision (7102-8999-9)
Pathology Services Histology Core Biopsies - Breast Requisition
Pathology Services Placental Examination Requisition (R250-10-38)
Pathology Services SBH Laboratory Requisition (R250-10-39)
Pathology Services SBH/Bethesda Laboratory Requisition (R250-10-40)
Peritoneal Dialysis - Kt/V Requisition (R250-10-84)
Please see current example of the CBS Requisition required in LIM entry's Comment Section below.
Rasburicase Protocol - Uric Acid
Repeat Diagnostics - Molecular
Request for Prothrombin Complex Concentrates (PCC) (F160-INV-16B)
Request for Release of Blood Components and Products (F160-INV-33)
Request for Release of Red Blood Cells (F160-INV-34)
Retrovirus Nucleic Acid Testing (CPL form MG5126)
SBH Biochemistry In-House Test Requisition (Blood, Urine & Misc)_2 Pages
SBH Biochemistry Referred-In Test Requisition (Blood)
SBH Biochemistry Referred-In Test Requisition (Urine & Misc)
SBH Biochemistry Timed Collection Booking Fax Form
SBH Hematology Test Requisition
SBH Test Add-On Form (Biochem, Hem, Imm) (F100-10-53E)
Saskatchewan Cytogenetic Requisition
SickKids Microarray Requisition
Specialist Endocrinology Requisition (R250-10-77)
Ste. Anne Hospital Requisition (R250-10-43)
Sudbury Cytogenetic Requisition
Sudbury Microarray Requisition
TRH Stimulation (Combined)
TRH/GnRH Stimulation Female
TRH/GnRH Stimulation Male
TRH/Prolactin Stimulation
TRH/TSH Stimulation
TST-15 Solid Tumour NGS Panel (UHN) Requisition_CCMB
The Pas Chemistry and Hematology Requisition (R250-10-57)
The Pas Microbiology Requisition (R250-10-54)
Thompson Chem-Hem-Urinalysis Lab Requisition (R250-10-25)
Transplant Immunology Test Requisition/Report (R250-10-63)
Triple Test Female
Triple Test Male
UCSD Biochemical Genetics/Cystine Lab Requisition
Urine and Body Fluid Requisition WL (R250-10-49)
Use 4-Part CBS Transfusion Reaction Investigation CM105 Form (DO NOT PRINT Online Form)
Vitamin D (25-Hydroxy) Requisition (R250-10-75)
Washington University Neuromuscular Clinical Laboratory - Antibody Testing Req
Westman Lab Chemistry & Hematology Requisition (Blood, Serum, Plasma) (100-904-0101)