Requisition PDFs

All Labs Biochemistry Immunology Microbiology Cytology Genomics Hematology Pathology Transfusion Medicine

ACTH (Cosyntropin) STIMULATION (regular dose)

Arginine Stimulation

CCMB Fecal Occult Blood Test Requisition (April 2022)

CHUS Biochemical Genetics

Cadham HIV Requisition

Canadian Blood Services (CBS)

Cervical Cytology Request Form

Cervical Cytology Request Form SBH/Bethesda

Clonidine Stimulation

Gastrin Secretin Stimulation Test

Glucagon Stimulation

Glucose GH Suppression

GnRH Stimulation Female

GnRH Stimulation Male

Growth Hormone Sleep Study

Hemostatsis Consult F140-80-48A

I-Stat Downtime Report (F100-10-02A)

IERHA Downtime Request and Report (R250-10-15)

IERHA Urinalysis Request and Report (R250-10-14)

Insulin Stimulation

L-Dopa Propanolol Stimulation

MNG Neurochemistry and Metabolic Test Request Form

Miscellaneous Test Report (Rural) F100-20-1100 V08

Pathology Lab Test Requisition (Form #BRH 012) - Westman Lab

Pathology Services HSC Laboratory Requisition (80993)

Pathology Services Histology Breast Requisition - Excision (7102-8999-9)

Pathology Services Histology Core Biopsies - Breast Requisition

Please see current example of the CBS Requisition required in LIM entry's Comment Section below.

Rasburicase Protocol - Uric Acid

SBH Biochemistry Timed Collection Booking Fax Form

SBH Test Add-On Form (Biochem, Hem, Imm) (F100-10-53E)

TRH Stimulation (Combined)

TRH/GnRH Stimulation Female

TRH/GnRH Stimulation Male

TRH/Prolactin Stimulation

TRH/TSH Stimulation

Triple Test Female

Triple Test Male

Use 4-Part CBS Transfusion Reaction Investigation CM105 Form (DO NOT PRINT Online Form)

_SH Adrenal Vein Sampling Requisition (R250-10-59)

_SH Anti-SARS-CoV-2 Antibody Detection Requisition (R250-10-96)

_SH Approval for Test Referral Biochemistry (F260-11-02)

_SH Approval for Test Referral Immunology and Hematology F150-100-100

_SH Biochemical Genetics Laboratory Requisition (R250-10-69)

_SH Biochemistry Hematology Requisition (R250-10-92)

_SH Body Fluid Requisition (R250-10-53)

_SH Bone Marrow Requisition (R250-10-86)

_SH Bone Marrow Review / Consult Request (F140-50-22)

_SH Bone Marrow Triage Confirmation Requisition (R250-10-101)

_SH CM077 Fax Notification (F160-INV-32)

_SH Cytogenetics & FISH - Prenatal Requisition (R250-10-73)

_SH Cytogenetics & FISH Hematology/Oncology Requistion (R250-10-72)

_SH Cytogenetics & FISH Tissues Requisition (R250-10-74)

_SH Cytogenetics & FISH – Constitutional requisition (R250-10-71)

_SH Drug Screen Consultation Requisition (R250-10-24)

_SH Emergency Urgent Care Laboratory Requisition (R250-10-88)

_SH Endocrinology (General) Primary Care Requisition (R250-10-76)

_SH Endocrinology (Specialist) Requisition (R250-10-77)

_SH Flow Cytometry Laboratory Requisition (R250-10-82)

_SH HIT Screen - Heparin Induced Thrombocytopenia Screening Requisition (R250-10-81)

_SH HSC Biochemistry Potassium (Hyperkalemia) Test Requisition (R250-10-01)

_SH HSC Molecular Diagnostic Lab Test Requisition (R250-10-09)

_SH HSC Molecular Hematopathology (R250-10-29)

_SH Haemostasis Test Requisition (R250-10-12)

_SH Hemoglobinopathy Investigation Requisition (R250-10-78)

_SH Hereditary Cancer Molecular Requisition (R250-10-10)

_SH Hospital Biochemistry Hematology Non Winnipeg Brandon (R250-10-91)

_SH Immunology Autoimmune Laboratory Requisition (R250-10-85)

_SH Immunology Test Requisition (R250-10-21)

_SH KR001 Molecular Pathology Requisition (R250-10-61)

_SH Microbiology - Provincial Requisition (R250-10-06)

_SH Molecular Diagnostic Lab (R250-10-09)

_SH Molecular Diagnostic Laboratory Out of Centre Genetic Test Requisition (R250-10-103)

_SH Non-Gynaecological Cytology Requisition - HSC (2 pages) (R250-10-30)

_SH Non-Gynaecological Cytology Requisition - SBH (2 pages) (R250-10-31)

_SH Non-Gynaecological Cytology Requisition - WL (R250-10-34)

_SH Order of Draw Chart for Phlebotomy (Poster F100-10-20)

_SH Pathology Services Placental Examination Requisition (R250-10-38)

_SH Pathology Services SBH Laboratory Requisition (R250-10-39)

_SH Pathology Services SBH/Bethesda Laboratory Requisition (R250-10-40)

_SH Peritoneal Dialysis - Kt/V Requisition (R250-10-84)

_SH Request for Prothrombin Complex Concentrates (PCC) (F160-INV-16B)

_SH Request for Release of Blood Components and Products (F160-INV-33)

_SH Request for Release of Red Blood Cells (F160-INV-34)

_SH Transplant Immunology Test Requisition/Report (R250-10-63)

_SH Urine Testing Requisition (R250-10-95)

_SH Vitamin D (25-Hydroxy) Requisition (R250-10-75)

_SH Winnipeg Brandon Biochemistry Hematology Requisition (R250-10-94)

_SH Winnipeg Brandon Hospital Biochemistry Hematology Requisition (R250-10-93)