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Biochemistry
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ACTH (Cosyntropin) STIMULATION (regular dose)
Adrenal Vein Sampling Requisition R250-10-59 V01
Approval for Test Referral Immunology and Hematology F150-100-100
Approval for test referral (F260-11-02)
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 V01
Bone Marrow Review / Consult Request
CS9248 Test Requisition (Stanford)
CYTOGENETICS & FISH -PRENATAL Requisition R250-10-73
CYTOGENETICS & FISH HEMATOLOGY/ONCOLOGY Requistion R250-10-72
CYTOGENETICS & FISH TISSUES Requisiton R250-10-74
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 V01
Clinical Microbiology - SBH Lab Test Requisition R250-10-07 V01
Clinical Microbiology - Westman Lab Test Requisition R250-10-08 V01
Clonidine Stimulation
Cytogenetic & FISH – Constitutional requisition (#R250-10-71)
Cytogenetic Requisition (200-10-06 V02) - HSC (Replaced by R250-10-71 thru 74)
Cytogenetic Requisition (200-10-06 V02) AND (Replaced by R250-10-71 thru 74)
Cytogentics Oncology Requisition #250-10-72
Dauphin Downtime Hematology Requisition F100-120-0105 V02
DeSalaberry Health Centre Lab Requisition R250-10-04 V01
Drug Screen Consultation Requisition R250-10-24 V03
FISH Panel - Mayo Clinic
Flin Flon Chemistry & Hematology Requisition R250-10-58 V02
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 General Hospital (GGH) - On Site Requisition R250-10-11 V01
Growth Hormone Sleep Study
HIT Screen - Heparin Induced Thrombocytopenia Screening Requisition R250-10-81
HSC Biochemistry Potassium (Hyperkalemia) Test Requisition R250-10-01 V01
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 V01
HSC Molecular Diagnostic Lab - Molecular Pathology Test Requisition R250-10-03 V01
HSC Molecular Diagnostic Lab Test Requistion R250-10-09
HSC Molecular Hematopathology, R250-10-29
Haemostasis Test Requisition R250-10-12 V04
Hamilton Health Sciences Molecular Diagnostic Genetics Requisition
Hemoglobinopathy Investigation Requisition R250-10-78
Hemostatsis Consult F140-80-48A
Hereditary Cancer Molecular, R250-10-10
I-Stat Requisition - Report F110-10-04A V05
IERHA Downtime Request and Report R250-10-15 V01
IERHA General Laboratory Requisition R250-10-13 V01
IERHA Urinalysis Request and Report R250-10-14 V01
IV Busulfex Pharmacokinetics Requisition
IVIG SCIG Physician Form (Follow Up) R250-10-68 V01
IVIG SCIG Physician Form (Initial Treatment) R250-10-67 V01
Immunology Test Requisition R250-10-21 V01
Insulin Stimulation
Killarney Lab and Imaging Requisition R250-10-23 V01
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 V01
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 V01
Pathology Services SBH Laboratory Requisition R250-10-39 V01
Pathology Services SBH/Bethesda Laboratory Requisition R250-10-40 V01
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 V03
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) 5648 F100-10-53E V02
Saskatchewan Cytogenetic Requisition
SickKids Microarray Requisition
Ste. Anne Hospital Requisition R250-10-43 V01
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 V02
The Pas Microbiology Requisition R250-10-54 V01
Thompson Chem-Hem-Urinalysis Lab Requisition R250-10-25 V01
Transplant Immunology Test Requisition/Report R250-10-63 V01
Triple Test Female
Triple Test Male
UCSD Biochemical Genetics/Cystine Lab Requisition
Urine and Body Fluid Requisition WL R250-10-49 V02
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) F100-904-0101 V07