Requisitions and Forms

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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) (Electronic Fillable Form)
Cord/Neonate Testing (ABO/Rh/DAT - HDFN Investigation)	Antibody Investigation Requisition BC (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) (Electronic Fillable Form)
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) (Electronic Fillable Form) RHD Genotyping (Frequently Asked Questions) (PDF) Information Regarding Limited Availability of RHD Genotyping Kits (PDF) Demande de génotypage RhD (PDF) (Peut être rempli en ligne)
Perinatal Supplies	Perinatal Supplies Request Form BC (PDF)

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) (Electronic Fillable Form)
Transfusion Reaction Investigation	Antibody Investigation Requisition BC (PDF) (Electronic Fillable Form)
RBC Genotyping Testing for RHCE and Extended Blood Groups	Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) (Electronic Fillable Form) Demande de génotypage sanguin (patient) (PDF) (Peut être rempli en ligne)
RHD Genotyping	Request for RHD Genotyping (PDF) (Electronic Fillable Form) RHD Genotyping (Frequently Asked Questions) (PDF) Information Regarding Limited Availability of RHD Genotyping Kits (PDF) Demande de génotypage RhD (PDF) (Peut être rempli en ligne)
Test for Anti-IgA	Patient Request for Anti-IgA Testing (PDF) (Electronic Fillable Form) Test for Anti-IgA (Frequently Asked Questions) (PDF) (Electronic Fillable Form)

PLATELET/HLA REQUISITIONS/FORM DESCRIPTION

TEST	SAMPLE REQUIREMENTS
Neonatal Platelet Investigation – Maternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Paternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Neonate/Amniotic Fluid	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Platelet Allo Immunization Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Post Transfusion Purpura Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
TRALI Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form) TRALI Patient Data Form (PDF) (Electronic Fillable Form)

Edmonton, AB

PERINATAL REQUISITIONS/FORM DESCRIPTION

TEST	REQUISITIONS AND FORMS
Maternal Testing (ABO/RhD Typing / Antibody Screen / Antibody ID)	Perinatal Testing for Red Blood Cell Serology (PDF) (Electronic Fillable Form)
Father’s ABO RhD and Phenotyping (Maternal clinically significant antibody or RhD negative)	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) (Electronic Fillable Form) Consent for Release of Neonatal Test Results (PDF)
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	Versiti Immunohematology Reference Laboratory Requisition (PDF) Perinatal Testing for Red Blood Cell Serology (PDF) (Electronic Fillable Form)
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) (Electronic Fillable Form) Demande de génotypage sanguin (patient) (NIRL) (PDF) (Peut être rempli en ligne)
RHD Genotyping	Request for RHD Genotyping (PDF) (Electronic Fillable Form) RHD Genotyping (Frequently Asked Questions) (PDF) Information Regarding Limited Availability of RHD Genotyping Kits (PDF) Demande de génotypage RhD (PDF) (Peut être rempli en ligne)
Test for Anti-IgA	Patient Request for Anti-IgA Testing (PDF) (Electronic Fillable Form) Test for Anti-IgA (Frequently Asked Questions) (PDF) (Electronic Fillable Form)

PLATELET/HLA REQUISITIONS/FORM DESCRIPTION

TEST	SAMPLE REQUIREMENTS
Neonatal Platelet Investigation – Maternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Paternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Neonate/Amniotic Fluid	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Platelet Allo Immunization Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Post Transfusion Purpura Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
TRALI Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form) TRALI Patient Data Form (PDF) (Electronic Fillable Form)

Regina, SK

REFERRAL REQUISITIONS/FORM DESCRIPTION

TEST	REQUISITIONS/FORMS
Red Cell Antibody Investigation	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups)	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Direct Antiglobulin Test (DAT)	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Transfusion Reaction Investigation	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
RBC Genotyping Testing for RHCE and Extended Blood Groups	Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) (Electronic Fillable Form) Demande de génotypage sanguin (patient) (PDF) (Peut être rempli en ligne)
RHD Genotyping	Request for RHD Genotyping (PDF) (Electronic Fillable Form) RHD Genotyping (Frequently Asked Questions) (PDF) Information Regarding Limited Availability of RHD Genotyping Kits (PDF) Demande de génotypage RhD (PDF) (Peut être rempli en ligne)
Test for Anti-IgA	Patient Request for Anti-IgA Testing (PDF) (Electronic Fillable Form) Test for Anti-IgA (Frequently Asked Questions) (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.	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)

PLATELET/HLA REQUISITIONS/FORM DESCRIPTION

TEST	SAMPLE REQUIREMENTS
Neonatal Platelet Investigation – Maternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Paternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Neonate/Amniotic Fluid	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Platelet Allo Immunization Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Post Transfusion Purpura Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
TRALI Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form) TRALI Patient Data Form (PDF) (Electronic Fillable Form)

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) (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.	International Blood Group Reference Laboratory Requisition DS (PDF) (Use the link to download the Fetal Genotyping from Maternal Blood form FRM4674) Request for Perinatal Testing (PDF) (Electronic Fillable Form)
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 Plasma Maternal Fetal Medicine Instructions (PDF)

REFERRAL REQUISITIONS/FORM DESCRIPTION

TEST	REQUISITIONS/FORMS
Red Cell Antibody Investigation	Request for Miscellaneous Testing Requisition (PDF) (Electronic Fillable Form)
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups)	Request for Miscellaneous Testing Requisition (PDF) (Electronic Fillable Form)
Direct Antiglobulin Test (DAT)	Request for Miscellaneous Testing Requisition (PDF) (Electronic Fillable Form)
Transfusion Reaction Investigation	Transfusion Reaction Investigation (PDF) (Electronic Fillable Form)
Cold Agglutinin Titre	Request for Miscellaneous Testing Requisition (PDF) (Electronic Fillable Form)
Isohemagglutinin Titre	Request for Miscellaneous Testing Requisition (PDF) (Electronic Fillable Form)
Thermal Amplitude	Request for Miscellaneous Testing Requisition (PDF) (Electronic Fillable Form)
RBC Genotyping Testing for RHCE and Extended Blood Groups	Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) (Electronic Fillable Form) Demande de génotypage sanguin (patient) (PDF) (Peut être rempli en ligne)
RHD Genotyping	Request for RHD Genotyping (PDF) (Electronic Fillable Form) RHD Genotyping (Frequently Asked Questions) (PDF) Information Regarding Limited Availability of RHD Genotyping Kits (PDF) Demande de génotypage RhD (PDF) (Peut être rempli en ligne)
Test for Anti-IgA	Patient Request for Anti-IgA Testing (PDF) (Electronic Fillable Form) Test for Anti-IgA (Frequently Asked Questions) (PDF) (Electronic Fillable Form)

CROSSMATCH REQUISITIONS/FORM DESCRIPTION

TEST	SAMPLE REQUIREMENTS
ABO Group /Rh Typing and Antibody Screen (Type and Screen)	Request for Pre-transfusion Testing (PDF) (Electronic Fillable Form) Request for Blood Components (PDF) (Electronic Fillable Form)
Crossmatch	Request for Pre-transfusion Testing (PDF) (Electronic Fillable Form) Request for Blood Components (PDF) (Electronic Fillable Form)
Direct Antiglobulin Test (DAT)	Request for Pre-transfusion Testing (PDF) (Electronic Fillable Form) Request for Blood Components (PDF) (Electronic Fillable Form)
Transfusion Reaction Investigation	Transfusion Reaction Investigation (PDF) (Electronic Fillable Form)
Isohemagglutinin Titre	Request for Miscellaneous Testing Requisition (PDF) (Electronic Fillable Form)

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) (Electronic Fillable Form)
Neonatal Platelet Investigation – Paternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Neonate/Amniotic Fluid	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Platelet Allo Immunization Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Post Transfusion Purpura Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
TRALI Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form) TRALI Patient Data Form (PDF) (Electronic Fillable Form)

National Platelet Immunology Reference Laboratory (NPIRL)

PLATELET/HLA REQUISITIONS/FORM DESCRIPTION

TEST	SAMPLE REQUIREMENTS
Neonatal Platelet Investigation – Maternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Paternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Neonate/Amniotic Fluid	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Platelet Allo Immunization Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Post Transfusion Purpura Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
TRALI Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form) TRALI Patient Data Form (PDF) (Electronic Fillable Form)

Brampton, ON

REFERRAL REQUISITIONS/FORM DESCRIPTION

TEST	REQUISITIONS/FORMS
Red Cell Antibody Investigation	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups)	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Direct Antiglobulin Test (DAT)	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Transfusion Reaction Investigation	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
RBC Genotyping Testing for RHCE and Extended Blood Groups	Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) (Electronic Fillable Form) Demande de génotypage sanguin (patient) (PDF) (Peut être rempli en ligne)
RHD Genotyping	Request for RHD Genotyping (PDF) (Electronic Fillable Form) RHD Genotyping (Frequently Asked Questions) (PDF) Information Regarding Limited Availability of RHD Genotyping Kits (PDF) Demande de génotypage RhD (PDF) (Peut être rempli en ligne)
Test for Anti-IgA	Patient Request for Anti-IgA Testing (PDF) (Electronic Fillable Form) Test for Anti-IgA (Frequently Asked Questions) (PDF) (Electronic Fillable Form)

PLATELET/HLA REQUISITIONS/FORM DESCRIPTION

TEST	SAMPLE REQUIREMENTS
Neonatal Platelet Investigation – Maternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Paternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Neonate/Amniotic Fluid	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Platelet Allo Immunization Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Post Transfusion Purpura Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
TRALI Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form) TRALI Patient Data Form (PDF) (Electronic Fillable Form)

NIRL

REFERRAL REQUISITIONS/FORM DESCRIPTION

TEST	REQUISITIONS/FORMS
Red Cell Antibody Investigation	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Discrepancy Resolution (ABO, Rh, Other Major Blood Groups)	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Direct Antiglobulin Test (DAT)	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
Transfusion Reaction Investigation	Request for Serological Investigation (PDF) (Electronic Fillable Form) Demande D'Investigation Serologique (PDF) (Peut être rempli en ligne)
RBC Genotyping Testing for RHCE and Extended Blood Groups	Requisition for Blood Group Genotyping - Patient (NIRL) (PDF) (Electronic Fillable Form) Demande de génotypage sanguin (patient) (PDF) (Peut être rempli en ligne)
RHD Genotyping	Request for RHD Genotyping (PDF) (Electronic Fillable Form) RHD Genotyping (Frequently Asked Questions) (PDF) Information Regarding Limited Availability of RHD Genotyping Kits (PDF) Demande de génotypage RhD (PDF) (Peut être rempli en ligne)
Test for Anti-IgA	Patient Request for Anti-IgA Testing (PDF) (Electronic Fillable Form) Test for Anti-IgA (Frequently Asked Questions) (PDF) (Electronic Fillable Form)

PLATELET/HLA REQUISITIONS/FORM DESCRIPTION

TEST	SAMPLE REQUIREMENTS
Neonatal Platelet Investigation – Maternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Paternal	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Neonatal Platelet Investigation – Neonate/Amniotic Fluid	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Platelet Allo Immunization Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
Post Transfusion Purpura Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form)
TRALI Investigation	Platelet Immunology Requisition (PDF) (Electronic Fillable Form) TRALI Patient Data Form (PDF) (Electronic Fillable Form)

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