Requisitions and Forms
Vancouver, BC
PERINATAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS AND FORMS |
|---|---|
Maternal Routine Testing (ABO/Rh Typing/Antibody Screen) | Perinatal Screen Request Requisition BC (PDF) (Electronic Fillable Form) |
Father's Rh Typing (when maternal Rh is negative) | Perinatal Screen Request Requisition BC (PDF) (Electronic Fillable Form) |
| ABO RH Typing/Antibody Screen “Fertility” Testing | Perinatal Screen Request Requisition BC (PDF) |
| Cord/Neonate Testing (ABO/Rh/DAT - HDFN Investigation) | Antibody Investigation Requisition BC (PDF) |
Fetal Genotyping from Maternal Plasma Requisitions Testing is only available for Canadian residents. Please contact International Blood Group Reference Laboratory for testing inquires. https://ibgrl.blood.co.uk/services/molecular-diagnostics/fetal-genotyping-diagnostic/ | International Blood Group Reference Laboratory Requisition DS (PDF) (Use the link to download the Fetal Genotyping from Maternal Blood form FRM4674) Fetal Genotyping from Maternal Plasma (PDF) Guidance for Completion of International Blood Group Laboratory Requisition |
| Fetal Genotyping from Maternal Plasma Consent | Consent_for_Release_of_Neonatal_Test_Results_Form_BC.pdf (PDF) |
| Fetal Genotyping from Maternal Plasma Instructions | Fetal Genotyping on Maternal Plasma Maternal Fetal Medicine Instructions (PDF) |
| RHD Genotyping | Request for RHD Genotyping (PDF) RHD Genotyping (Frequently Asked Questions) (PDF) Demande de génotypage RhD (PDF) |
| Perinatal Supplies |
REFERRAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS/FORMS |
|---|---|
Red Cell Antibody Investigation | Antibody Investigation Requisition BC (PDF) (Electronic Fillable Form) |
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups) | Antibody Investigation Requisition BC (PDF) (Electronic Fillable Form) |
| Direct Antiglobulin Test (DAT) | Antibody Investigation Requisition BC (PDF) |
| Transfusion Reaction Investigation | Antibody Investigation Requisition BC (PDF) |
| RBC Genotyping Testing for RHCE and Extended Blood Groups | Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) |
| RHD Genotyping | Request for RHD Genotyping (PDF) RHD Genotyping (Frequently Asked Questions) (PDF) Demande de génotypage RhD (PDF) |
| Test for Anti-IgA | Patient Request for Anti-IgA Testing (PDF) Test for Anti-IgA (Frequently Asked Questions) (PDF) |
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
HLA Disease Association – HLA-B27, HLA-A, HLA-B, HLA-DR, HLA-DQ Pharmacogenomic Testing – HLA-B*57:01 | Platelet Immunology Requisition (PDF) (Electronic Fillable Form) |
| Neonatal Platelet Investigation – Maternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Paternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Neonate/Amniotic Fluid | Platelet Immunology Requisition (PDF) |
Platelet Allo Immunization Investigation | Platelet Immunology Requisition (PDF) |
Post Transfusion Purpura Investigation | Platelet Immunology Requisition (PDF) |
| TRALI Investigation | Platelet Immunology Requisition (PDF) TRALI Patient Data Form (PDF) |
Edmonton, AB
PERINATAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS AND FORMS |
|---|---|
Maternal Routine Testing (ABO/Rh Typing/Antibody Screen) | Perinatal Testing for Red Blood Cell Serology (PDF) |
Father's Rh Typing (when maternal Rh is negative) - when requested by Canadian Blood Services | Perinatal Testing for Red Blood Cell Serology (PDF) (Electronic Fillable Form) |
Fetal Genotyping from Maternal Plasma Requisitions Testing is only available for Canadian residents. Please contact International Blood Group Reference Laboratory for testing inquires. https://ibgrl.blood.co.uk/services/molecular-diagnostics/fetal-genotyping-diagnostic/ | International Blood Group Reference Laboratory Requisition DS (PDF) (Use the link to download the Fetal Genotyping from Maternal Blood form FRM4674) Fetal Genotyping from Maternal Plasma (PDF) Guidance for Completion of International Blood Group Laboratory Requisition |
| Fetal Genotyping from Maternal Plasma Consent | Consent for Release of Neonatal Test Results (PDF) |
Fetal Genotyping from Maternal Plasma Instructions | Fetal Genotyping on Maternal Plasma Collection Site Instructions AB (PDF) Fetal Genotyping on Maternal Plasma Maternal Fetal Medicine Instructions (PDF) |
| Fetal Genotyping from Amniotic Fluid Requisitions | Blood Center of Wisconsin Molecular Diagnostics Lab (PDF) |
| Fetal Genotyping from Amniotic Fluid Instructions | Fetal Genotyping on Amniotic Fluid Testing Criteria and Collection Instructions (PDF) |
REFERRAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS/FORMS |
|---|---|
| RBC Genotyping Testing for RHCE and Extended Blood Groups | Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) Demande de génotypage sanguin (patient) (NIRL) (PDF) |
| RHD Genotyping | Request for RHD Genotyping (PDF) RHD Genotyping (Frequently Asked Questions) (PDF) Demande de génotypage RhD (PDF) |
| Test for Anti-IgA | Patient Request for Anti-IgA Testing (PDF) Test for Anti-IgA (Frequently Asked Questions) (PDF) |
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
HLA Disease Association – HLA-B27, HLA-A, HLA-B, HLA-DR, HLA-DQ Pharmacogenomic Testing – HLA-B*57:01 | Platelet Immunology Requisition (PDF) (Electronic Fillable Form) |
Neonatal Platelet Investigation – Maternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Paternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Neonate/Amniotic Fluid | Platelet Immunology Requisition (PDF) |
Platelet Allo Immunization Investigation | Platelet Immunology Requisition (PDF) |
Post Transfusion Purpura Investigation | Platelet Immunology Requisition (PDF) |
| TRALI Investigation | Platelet Immunology Requisition (PDF) TRALI Patient Data Form (PDF) |
Regina, SK
REFERRAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS/FORMS |
|---|---|
Red Cell Antibody Investigation | Request for Serological Investigation (PDF) |
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups) | Request for Serological Investigation (PDF) |
| Direct Antiglobulin Test (DAT) | Request for Serological Investigation (PDF) |
| Transfusion Reaction Investigation | Request for Serological Investigation (PDF) |
| RBC Genotyping Testing for RHCE and Extended Blood Groups | Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) |
| RHD Genotyping | Request for RHD Genotyping (PDF) RHD Genotyping (Frequently Asked Questions) (PDF) Demande de génotypage RhD (PDF) |
| Test for Anti-IgA | Patient Request for Anti-IgA Testing (PDF) Test for Anti-IgA (Frequently Asked Questions) (PDF) |
Fetal Genotyping from Maternal Plasma Requisitions Testing is only available for Canadian residents. Please contact International Blood Group Reference Laboratory for testing inquires. | Guidance for Completion of International Blood Group Laboratory Requisition |
Fetal Genotyping from Maternal Plasma Consent | Consent for Release of Neonatal Test Results (PDF) |
Fetal Genotyping from Maternal Plasma Instructions | Fetal Genotyping on Maternal Plasma Collection Site Instructions (PDF) Fetal Genotyping on Maternal Blood Testing Criteria and Collection Instructions (PDF) |
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
HLA Disease Association – HLA-B27, HLA-A, HLA-B, HLA-DR, HLA-DQ Pharmacogenomic Testing – HLA-B*57:01 | Platelet Immunology Requisition (PDF) (Electronic Fillable Form) |
| Neonatal Platelet Investigation – Maternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Paternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Neonate/Amniotic Fluid | Platelet Immunology Requisition (PDF) |
Platelet Allo Immunization Investigation | Platelet Immunology Requisition (PDF) |
Post Transfusion Purpura Investigation | Platelet Immunology Requisition (PDF) |
| TRALI Investigation | Platelet Immunology Requisition (PDF) TRALI Patient Data Form (PDF) |
Winnipeg, MB
PERINATAL REQUISITIONS/FORM DESCRIPTION
| TEST | REQUISITIONS/FORMS |
|---|---|
Maternal Routine Testing (ABO/Rh Typing/Antibody Screen) | Request for Perinatal Testing (PDF) (Electronic Fillable Form) |
Father's Rh Typing (when maternal Rh is negative) - when requested by Canadian Blood Services | Request for Perinatal Testing (PDF) (Electronic Fillable Form) |
| Cord/Neonate Testing (ABO/Rh/DAT - HDFN Investigation) | Request for Cord - Neonate Blood Testing Requisition (MB) (PDF) |
| Post Natal Testing - Rh Negative Mothers | Request for Perinatal Testing (PDF) (Electronic Fillable Form) |
| Fetal Bleed Screening Test (FMH Rapid Screen) | Request for Perinatal Testing (PDF) (Electronic Fillable Form) |
Kleihauer-Betke - Quantitative Test for Fetal Bleed | Request for Perinatal Testing (PDF) |
Fetal Genotyping from Maternal Plasma Requisitions Testing is only available for Canadian residents. Please contact International Blood Group Reference Laboratory for testing inquires. | International Blood Group Reference Laboratory Requisition DS (PDF) (Use the link to download the Fetal Genotyping from Maternal Blood form FRM4674) Guidance for Completion of International Blood Group Laboratory Requisition |
Fetal Genotyping from Maternal Plasma Consent | |
Fetal Genotyping from Maternal Plasma Instructions | Fetal Genotyping on Maternal Plasma Collection Site Instructions (PDF) |
REFERRAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS/FORMS |
|---|---|
Red Cell Antibody Investigation | Request for Miscellaneous Testing Requisition (PDF) |
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups) | Request for Miscellaneous Testing Requisition (PDF) |
Direct Antiglobulin Test (DAT) | Request for Miscellaneous Testing Requisition (PDF) |
Transfusion Reaction Investigation | Transfusion Reaction Investigation (PDF) |
Cold Agglutinin Titre | Request for Miscellaneous Testing Requisition (PDF) |
Isohemagglutinin Titre | Request for Miscellaneous Testing Requisition (PDF) |
Thermal Amplitude | Request for Miscellaneous Testing Requisition (PDF) |
RBC Genotyping Testing for RHCE and Extended Blood Groups | Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) |
RHD Genotyping | Request for RHD Genotyping (PDF) RHD Genotyping (Frequently Asked Questions) (PDF) Demande de génotypage RhD (PDF) |
Test for Anti-IgA | Patient Request for Anti-IgA Testing (PDF) Test for Anti-IgA (Frequently Asked Questions) (PDF) |
CROSSMATCH REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
ABO Group /Rh Typing and Antibody Screen (Type and Screen) | Request for Pre-transfusion Testing (PDF) Request for Blood Components (PDF) |
Crossmatch | Request for Pre-transfusion Testing (PDF) Request for Blood Components (PDF) |
| Direct Antiglobulin Test (DAT) | Request for Pre-transfusion Testing (PDF) Request for Blood Components (PDF) |
| Transfusion Reaction Investigation | Transfusion Reaction Investigation (PDF) |
| Isohemagglutinin Titre | Request for Miscellaneous Testing Requisition (PDF) |
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
HLA Disease Association – HLA-B27, HLA-A, HLA-B, HLA-DR, HLA-DQ Pharmacogenomic Testing – HLA-B*57:01 | Platelet Immunology Requisition (PDF) (Electronic Fillable Form) |
| Neonatal Platelet Investigation – Maternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Paternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Neonate/Amniotic Fluid | Platelet Immunology Requisition (PDF) |
Platelet Allo Immunization Investigation | Platelet Immunology Requisition (PDF) |
Post Transfusion Purpura Investigation | Platelet Immunology Requisition (PDF) |
| TRALI Investigation | Platelet Immunology Requisition (PDF) TRALI Patient Data Form (PDF) |
HistoTrac Example Report | HistoTrac Example Report (PDF) |
National Platelet Immunology Reference Laboratory (NPIRL)
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
HLA Disease Association – HLA-B27, HLA-A, HLA-B, HLA-DR, HLA-DQ Pharmacogenomic Testing – HLA-B*57:01 | Platelet Immunology Requisition (PDF) (Electronic Fillable Form) |
| Neonatal Platelet Investigation – Maternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Paternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Neonate/Amniotic Fluid | Platelet Immunology Requisition (PDF) |
Platelet Allo Immunization Investigation | Platelet Immunology Requisition (PDF) |
Post Transfusion Purpura Investigation | Platelet Immunology Requisition (PDF) |
| TRALI Investigation | Platelet Immunology Requisition (PDF) TRALI Patient Data Form (PDF) |
HistoTrac Example Report | HistoTrac Example Report (PDF) |
Brampton, ON
REFERRAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS/FORMS |
|---|---|
Red Cell Antibody Investigation | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups) | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
| Direct Antiglobulin Test (DAT) | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
| Transfusion Reaction Investigation | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
| RBC Genotyping Testing for RHCE and Extended Blood Groups | Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) |
| RHD Genotyping | Request for RHD Genotyping (PDF) RHD Genotyping (Frequently Asked Questions) (PDF) Demande de génotypage RhD (PDF) |
| Test for Anti-IgA | Patient Request for Anti-IgA Testing (PDF) Test for Anti-IgA (Frequently Asked Questions) (PDF) |
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
HLA Disease Association – HLA-B27, HLA-A, HLA-B, HLA-DR, HLA-DQ Pharmacogenomic Testing – HLA-B*57:01 | Platelet Immunology Requisition (PDF) (Electronic Fillable Form) |
| Neonatal Platelet Investigation – Maternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Paternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Neonate/Amniotic Fluid | Platelet Immunology Requisition (PDF) |
Platelet Allo Immunization Investigation | Platelet Immunology Requisition (PDF) |
Post Transfusion Purpura Investigation | Platelet Immunology Requisition (PDF) |
| TRALI Investigation | Platelet Immunology Requisition (PDF) TRALI Patient Data Form (PDF) |
NIRL
REFERRAL REQUISITIONS/FORM DESCRIPTION
TEST | REQUISITIONS/FORMS |
|---|---|
Red Cell Antibody Investigation | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups) | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
| Direct Antiglobulin Test (DAT) | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
| Transfusion Reaction Investigation | Request for Serological Investigation (PDF) Demande D'Investigation Serologique (PDF) |
RBC Genotyping Testing for RHCE and Extended Blood Groups | Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) |
RHD Genotyping | Request for RHD Genotyping (PDF) RHD Genotyping (Frequently Asked Questions) (PDF) Demande de génotypage RhD (PDF) |
Test for Anti-IgA | Patient Request for Anti-IgA Testing (PDF) Test for Anti-IgA (Frequently Asked Questions) (PDF) |
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
HLA Disease Association – HLA-B27, HLA-A, HLA-B, HLA-DR, HLA-DQ Pharmacogenomic Testing – HLA-B*57:01 | Platelet Immunology Requisition (PDF) (Electronic Fillable Form) |
| Neonatal Platelet Investigation – Maternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Paternal | Platelet Immunology Requisition (PDF) |
Neonatal Platelet Investigation – Neonate/Amniotic Fluid | Platelet Immunology Requisition (PDF) |
Platelet Allo Immunization Investigation | Platelet Immunology Requisition (PDF) |
Post Transfusion Purpura Investigation | Platelet Immunology Requisition (PDF) |
| TRALI Investigation | Platelet Immunology Requisition (PDF) TRALI Patient Data Form (PDF) |