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) |
| 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) |
| 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) Information Regarding Limited Availability of RHD Genotyping Kits (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) Information Regarding Limited Availability of RHD Genotyping Kits (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 |
|---|---|
| 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 Testing (ABO/RhD Typing / Antibody Screen / Antibody ID) | Perinatal Testing for Red Blood Cell Serology (PDF) |
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) |
| 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) |
| 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) Information Regarding Limited Availability of RHD Genotyping Kits (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 |
|---|---|
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) Information Regarding Limited Availability of RHD Genotyping Kits (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) |
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
| 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) |
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) Information Regarding Limited Availability of RHD Genotyping Kits (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) |
| 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) |
National Platelet Immunology Reference Laboratory (NPIRL)
PLATELET/HLA REQUISITIONS/FORM DESCRIPTION
TEST | SAMPLE REQUIREMENTS |
|---|---|
| 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) |
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) Information Regarding Limited Availability of RHD Genotyping Kits (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 |
|---|---|
| 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) Information Regarding Limited Availability of RHD Genotyping Kits (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 |
|---|---|
| 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) |