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Test Request Forms

Diagnostic Services
Winnipeg Centre

The test request forms / requisitions are available for viewing below. Please contact the laboratory to obtain the requisitions to be submitted with samples because many of these are multi-part and two-sided forms.

Crossmatch Request Forms

Request for Blood Components (PDF)

Request for Pre-transfusion Testing (PDF)

Request for Miscellaneous Testing (PDF)

Transfusion Reaction Investigation (PDF)

Fax Notification – WRHA Trace Line Sites (PDF)

Fax Notification – Rural Trace Line Sites (PDF)

Fax Notification – Rural Non-Trace Line Sites (PDF)

Request for HLA/HPA Selected Platelets (PDF)

HLA/HPA Selected Platelet Report (PDF)

Perinatal Test Request Forms

Request for Perinatal Testing (PDF)

Request for Cord / Neonate Blood Testing (PDF)

Platelet Immunology Form

Platelet Immunology Requisition (PDF)

Other Forms

Requisition for Blood Group Genotyping (NIRL) (PDF)
F800437 Request for Serological Investigation (PDF)
Request for RHD Genotyping (PDF)
IgA anti-IgA Patient Request Form (PDF)