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Requisitions and Forms

Vancouver, BC 

PERINATAL REQUISITIONS/FORM DESCRIPTION

TEST

REQUISITIONS/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

International Blood Group Reference Laboratory Requisition DS (PDF)

Perinatal Screen Request Requisition BC (PDF)
(Electronic Fillable Form)

Guidance for Completion of International Blood Group Laboratory Requisition (PDF)

Fetal Genotyping from Maternal Plasma Consent 

Consent for Release of Neonatal Test Results Form BC (PDF)

Fetal Genotyping from Maternal Plasma Instructions

Fetal Genotyping from Maternal Plasma Testing Criteria and Instructions BC

RHD Genotyping

Request for RHD Genotyping (PDF)
(Electronic Fillable Form)

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)

    Demande de génotypage RhD (PDF)
    (Peut être rempli en ligne)

    Test for Anti-IgA

    Patient Request for Anti-IgA Testing (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)

    Edmonton, AB

    PERINATAL REQUISITIONS/FORM DESCRIPTION

    TEST

    REQUISITIONS/FORMS

    Maternal Routine Testing (ABO/Rh Typing/Antibody Screen)                                                

    Perinatal Testing for Red Blood Cell Serology (PDF)
    (Electronic Fillable Form)

    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)
    Cord/Neonate  Testing (ABO/Rh/DAT - HDFN Investigation)Perinatal Testing for Red Blood Cell Serology (PDF)
    (Electronic Fillable Form)
    Post Natal Testing - Rh Negative MothersPerinatal Testing for Red Blood Cell Serology (PDF)
    (Electronic Fillable Form)
    Fetal Bleed Screening Test (FMH Rapid Screen)

    Perinatal Testing for Red Blood Cell Serology (PDF)
    (Electronic Fillable Form)

    Request for Serological Investigation​ (PDF)
    (Electronic Fillable Form)

    Kleihauer-Betke - Quantitative Test for Fetal Bleed

    Perinatal Testing for Red Blood Cell Serology (PDF)
    (Electronic Fillable Form)

    Request for Serological Investigation​ (PDF)
    (Electronic Fillable Form)

    Fetal Genotyping from Maternal Plasma Requisitions

    International Blood Group Reference Laboratory (PDF)
    Perinatal Testing for Red Blood Cell Serology (PDF) (Electronic Fillable Form)
    Guidance for Completion of International Blood Group Laboratory Requisition (PDF)

    Fetal Genotyping on Maternal Plasma Updates AB (PDF)

    Fetal Genotyping from Maternal Plasma Consent

    Consent for Release of Neonatal Test Results Form AB (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)

    Fetal Genotyping from Amniotic Fluid Requisitions

    Versiti Molecular Diagnostics 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 Critera and Collection Instructions (PDF)
    RHD Genotyping

    Request for RHD Genotyping (PDF)
    (Electronic Fillable Form)

    Demande de génotypage RhD (PDF)
    (Peut être rempli en ligne)

    REFERRAL REQUISITIONS/FORM DESCRIPTION

    TEST

    REQUISITIONS/FORMS

    Red Cell Antibody Investigation

    Request for Serological Investigation​ (PDF)
    (Electronic Fillable Form)

    Discrepancy Resolution (ABO, Rh, Other Major Blood Groups)

    Request for Serological Investigation​ (PDF)
    (Electronic Fillable Form)
    Direct Antiglobulin Test (DAT)

    Request for Serological Investigation​ (PDF)
    (Electronic Fillable Form)

    RBC Genotyping Testing for RHCE and Extended Blood Groups

    Request for Patient Blood Group Genotyping AB (PDF)
    (Electronic Fillable Form)

    RHD Genotyping

    Request for RHD Genotyping (PDF)
    (Electronic Fillable Form)

    Demande de génotypage RhD (PDF)
    (Peut être rempli en ligne)

    Test for Anti-IgA

    Patient Request for Anti-IgA Testing (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)

      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)

      Demande de génotypage RhD (PDF)
      (Peut être rempli en ligne)

      Test for Anti-IgA

      Patient Request for Anti-IgA Testing (PDF)
      (Electronic Fillable Form)

      Fetal Genotyping from Maternal Plasma Requisitions

      International Blood Group Reference Laboratory (PDF)

      Guidance for Completion of International Blood Group Laboratory Requistion (PDF)
      Fetal Genotyping on Maternal Plasma Updates (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 (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)
      (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)

      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 MothersRequest 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

      International Blood Group Reference Laboratory (PDF)

      Request for Perinatal Testing (PDF)
      (Electronic Fillable Form)
      Guidance for Completion of International Blood Group Laboratory Requisition (PDF)
      Fetal Genotyping on Maternal Plasma Updates (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 (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)

      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)
      (Electronic Fillable Form)
      Demande de génotypage sanguin (patient) (PDF)
      (Peut être rempli en ligne)

      RHD Genotyping                                       

       

      Request for RHD Genotyping (PDF)
      (Electronic Fillable Form)

      Demande de génotypage RhD (PDF)
      (Peut être rempli en ligne)

      Test for Anti-IgA

      Patient Request for Anti-IgA Testing (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)
      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 TitreRequest 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)
      (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)

      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)
      (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)

      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)

      Demande de génotypage RhD (PDF)
      (Peut être rempli en ligne)

      Test for Anti-IgA

      Patient Request for Anti-IgA Testing (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)

      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)

      Demande de génotypage RhD (PDF)
      (Peut être rempli en ligne)

      Test for Anti-IgA

      Patient Request for Anti-IgA Testing (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)