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)

Father's Rh Typing  (when maternal Rh is negative)

Perinatal Screen Request Requisition BC (PDF)
ABO RH Typing/Antibody Screen “Fertility” TestingPerinatal Screen Request Requisition BC (PDF)
Cord/Neonate  Testing (ABO/Rh/DAT - HDFN Investigation)

Antibody Investigation Requisition BC (PDF)

Fetal Genotyping from Maternal Plasma Requisitions

International Blood Group Reference Laboratory Requisition DS (PDF)

Perinatal Screen Request Requisition BC (PDF)

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 InstructionsFetal Genotyping from Maternal Plasma Testing Criteria and Instructions BC
RHD GenotypingRequest for RHD Genotyping (PDF)
Demande de génotypage RhD (AB)
Perinatal SuppliesPerinatal Supplies Request Form BC (PDF)

    REFERRAL REQUISITIONS/FORM DESCRIPTION

    TEST

    REQUISITIONS/FORMS

    Red Cell Antibody Investigation

    Antibody Investigation Requisition BC (PDF)

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

    Antibody Investigation Requisition BC (PDF)
    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 GroupsRequisition for Blood Group Genotyping - Patient (NIRL) (PDF)
    Demande de génotypage sanguin (patient) (NIRL) (PDF)
    RHD Genotyping

    Request for RHD Genotyping (Edmonton) (PDF)

    Demande de génotypage RhD (PDF)

    Test for Anti-IgARequest for Patient Anti-IgA Testing (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 – MaternalPlatelet Immunology Requisition (PDF)
    Neonatal Platelet Investigation – PaternalPlatelet Immunology Requisition (PDF)
    Neonatal Platelet Investigation – Neonate/Amniotic FluidPlatelet Immunology Requisition (PDF)
    Platelet Allo Immunization InvestigationPlatelet Immunology Requisition (PDF)
    Post Transfusion Purpura InvestigationPlatelet Immunology Requisition (PDF)
    TRALI Investigation

    Platelet Immunology Requisition (PDF)

    TRALI Patient Data Form (PDF)

    Edmonton, AB

    PERINATAL REQUISITIONS/FORM DESCRIPTION

    TEST

    REQUISITIONS/FORMS

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

    Requisition provided by Service Alberta and can be obtained by registering here

    Perinatal Follow-up Testing Requisition (PDF)

    Father's Rh Typing (when maternal Rh is negative) - when requested by Canadian Blood Services

    Perinatal Follow-up Testing Requisition (PDF)
    Cord/Neonate  Testing (ABO/Rh/DAT - HDFN Investigation)Perinatal Follow-up Testing Requisition (PDF)
    Post Natal Testing - Rh Negative MothersPerinatal Follow-up Testing Requisition (PDF)
    Fetal Bleed Screening Test (FMH Rapid Screen)

    Perinatal Follow-up Testing Requisition (PDF)

    Request for Serological Investigation​ (PDF)

    Kleihauer-Betke - Quantitative Test for Fetal Bleed

    Perinatal Follow-up Testing Requisition (PDF)

    Request for Serological Investigation​ (PDF)

    Fetal Genotyping from Maternal Plasma Requisitions

    International Blood Group Reference Laboratory (PDF)
    Perinatal Follow-up Testing Requisition (PDF)
    Guidance for Completion of International Blood Group Laboratory Requistion (PDF)

    Fetal Genotyping on Maternal Plasma Updates AB (PDF)

    Fetal Genotyping on Maternal Plasma Collection Site Instructions AB (PDF)

    Fetal Genotyping on Maternal Plasma Testing Criteria and Instructions AB (PDF)

    Fetal Genotyping from Maternal Plasma ConsentConsent 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 Follow-up Testing Requisition (PDF)

    Fetal Genotyping from Amniotic Fluid InstructionsFetal Genotyping on Amniotic Fluid Testing Critera and Collection Instructions (PDF)
    RHD GenotypingRequest for RHD Genotyping (PDF)
    Demande de génotypage RhD (AB) (PDF)
    Doctor and Clinic Supply Order FormDoctor and Clinic Supply Order Form (PDF)

    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)

    RBC Genotyping Testing for RHCE and Extended Blood GroupsRequest for Patient Blood Group Genotyping Requisition AB (PDF)
    RHD GenotypingRequest for RHD Genotyping (PDF)
    Demande de génotypage RhD (AB) (PDF)
    Test for Anti-IgARequest for Patient Anti-IgA Testing (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 – MaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – PaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – Neonate/Amniotic FluidPlatelet Immunology Requisition (PDF)
      Platelet Allo Immunization InvestigationPlatelet Immunology Requisition (PDF)
      Post Transfusion Purpura InvestigationPlatelet Immunology Requisition (PDF)
      TRALI Investigation

      Platelet Immunology Requisition (PDF)

      TRALI Patient Data Form (PDF)

      Regina, SK

      PERINATAL REQUISITIONS/FORM DESCRIPTION

      TEST

      REQUISITIONS/FORMS

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

      Request for Perinatal Testing Requisition SK (PDF)

      Father's Rh Typing (when maternal Rh is negative) 

      Request for Perinatal Testing Requisition SK (PDF)
      ABO RH Typing / Antibody Screen “Fertility” TestingRequest for Perinatal Testing Requisition SK (PDF)
      Cord / Neonate  Testing (ABO/Rh/DAT - HDFN Investigation)Antibody Investigation Requisition BC (PDF)
      Fetal Genotyping from Maternal Plasma Requisitions

      International Blood Group Reference Laboratory (PDF)

      Request for Perinatal Testing Requisition SK (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)
      RHD GenotypingRequest for RHD Genotyping (PDF)
      Demande de génotypage RhD (AB) (PDF)
      Utilization Of Rh Immune Globulin (form)                                                                                                                                              Utilization of Rh Immune Globulin

      REFERRAL REQUISITIONS/FORM DESCRIPTION

      TEST

      REQUISITIONS/FORMS

      Red Cell Antibody Investigation 

      Antibody Investigation Requisition BC (PDF)

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

      Antibody Investigation Requisition BC (PDF)
      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)
      Demande de génotypage sanguin (patient) (PDF)

      RHD Genotyping

      Request for RHD Genotyping (PDF)
      Demande de génotypage RhD (AB) (PDF

      Test for Anti-IgA

      Request for Patient Anti-IgA Testing (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 – MaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – PaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – Neonate/Amniotic FluidPlatelet Immunology Requisition (PDF)
      Platelet Allo Immunization InvestigationPlatelet Immunology Requisition (PDF)
      Post Transfusion Purpura InvestigationPlatelet 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)

      Father's Rh Typing (when maternal Rh is negative) - when requested by Canadian Blood Services

      Request for Perinatal Testing (PDF)
      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)
      Fetal Bleed Screening Test (FMH Rapid Screen)Request for Perinatal Testing (PDF)

      Kleihauer-Betke - Quantitative Test for Fetal Bleed

      Request for Perinatal Testing (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 TitreRequest for Miscellaneous Testing Requisition (PDF)
      Isohemagglutinin TitreRequest for Miscellaneous Testing Requisition (PDF)
      Thermal AmplitudeRequest for Miscellaneous Testing Requisition (PDF)
      RBC Genotyping Testing for RHCE and Extended Blood GroupsRequisition for Blood Group Genotyping - Patient (NIRL) (PDF)
      Demande de génotypage sanguin (patient) (NIRL) (PDF)
      RHD Genotyping                                       Request for RHD Genotyping (PDF)
      Demande de génotypage RhD (AB) (PDF)
      Test for Anti-IgARequest for Patient Anti-IgA Testing (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 TitreRequest for Miscellaneous Testing Requisition (PDF)
      Consumables Order FormConsumables Order Form (PDF)
      Stock Red Cells Order FormStock Red Cell Order Form - Trace Line Non-Testing Sites (PDF)
      Emergency Uncrossmatched Red Cells Order FormEmergency Uncrossmatched Red Cell Order Form - Non Trace Line Sites (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 – MaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – PaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – Neonate/Amniotic FluidPlatelet Immunology Requisition (PDF)
      Platelet Allo Immunization InvestigationPlatelet Immunology Requisition (PDF)
      Post Transfusion Purpura InvestigationPlatelet 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

      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 – MaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – PaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – Neonate/Amniotic FluidPlatelet Immunology Requisition (PDF)
      Platelet Allo Immunization InvestigationPlatelet Immunology Requisition (PDF)
      Post Transfusion Purpura InvestigationPlatelet 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 GroupsRequisition for Blood Group Genotyping - Patient (NIRL) (PDF)
      Demande de génotypage sanguin (patient) (NIRL) (PDF)
      RHD GenotypingRequest for RHD Genotyping (PDF)
      Demande de génotypage sanguin (patient) (NIRL) (PDF)
      Test for Anti-IgARequest for Patient Anti-IgA Testing (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 – MaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – PaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – Neonate/Amniotic FluidPlatelet Immunology Requisition (PDF)
      Platelet Allo Immunization InvestigationPlatelet Immunology Requisition (PDF)
      Post Transfusion Purpura InvestigationPlatelet 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

      Demande D'Investigation Serologique (PDF)

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

      Request for Serological Investigation

      Demande D'Investigation Serologique (PDF)

      Direct Antiglobulin Test (DAT)

      Request for Serological Investigation

      Demande D'Investigation Serologique (PDF)

      Transfusion Reaction Investigation 

      Request for Serological Investigation

      Demande D'Investigation Serologique (PDF)

      RBC Genotyping Testing for RHCE and Extended Blood GroupsRequisition for Blood Group Genotyping - Patient (NIRL) (PDF)
      Demande de génotypage sanguin (patient) (PDF)
      RHD GenotypingRequest for RHD Genotyping (PDF)
      Demande de génotypage RhD (AB)
      Test for Anti-IgARequest for Patient Anti-IgA Testing (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 – MaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – PaternalPlatelet Immunology Requisition (PDF)
      Neonatal Platelet Investigation – Neonate/Amniotic FluidPlatelet Immunology Requisition (PDF)
      Platelet Allo Immunization InvestigationPlatelet Immunology Requisition (PDF)
      Post Transfusion Purpura InvestigationPlatelet Immunology Requisition (PDF)
      TRALI Investigation

      Platelet Immunology Requisition (PDF)

      TRALI Patient Data Form (PDF)