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Pathology and Laboratory Medicine
Requisitions

The laboratory strives to support effective patient care. Information provided on the requisitions is important to ensure accurate testing.

If you frequently use a requisition, we recommend you create a shortcut for quick access and to ensure you are using the most up-to date version.

Completion aids are provided below to assist with questions you may have. If you feel some helpful information is missing, please let us know so we can update the aids.

Please note: All requests for patient testing must come from a physician. Patients cannot receive test results directly from the laboratory and must request them from their ordering physician.

Anatomic Pathology

​Name

​Requisition

​Completion Aid

​Surgical Pathology Requisition
Form #4030


Chemistry

​Name

​Requisition

​Completion Aid

​Allergy Testing Requisition
Form #101214
​Cancer Centre Requisition
Stem Cell Program
Form #102157
​Miscellaneous Specimen Requisition
Form #101878
​STAT/URGENT Transplant Workup Requisition
Form #103103
 
​Post-Vasectomy Semen Analysis Requisition

 

Cytogenetics/Human Molecular Genetics

​Name

Requisition​

​Completion Aid

Cytogenetics Testing Requisition


Human Molecular Genetics Testing Requisition
(For Hematology and tumor testing only)


​Medical Genetics Testing
(for more information refer to Genetic Testing/Molecular Genetics

​Requisition for Microarray (array CGH) Analysis


Cytology

Name​

​Requisition

​Completion Aid

Cervical Cytological (PAP) Requisition
Form #101092​
Non-Gynecological Cytology Requisition
Form #101157​

 

General

Name​

​Requisition

​Completion Aid

​Acute Care Phlebotomy Requisition
Form #101062
​Basic Semen Analysis Requisition
​Blood/Body Fluid Exposure - Exposed

​Blood/Body Fluid Exposure - Source

​Care Provider Request for Laboratory Report Distribution


Community Laboratory Requisition
Form #101064​

 

If submitting for Microbiology testing MUST include:

 

Community Mobile Phlebotomy Requisition
Form #103559​
​Community Paramedicine Phlebotomy Requisition
Form #104038
​Downtime Order Communication
Requisition/Referral
Form #101761
​Requisition for FIT Testing (RRPL)

You will be redirected to the RRPL ​Requisition
Roy Romanow Provincial Laboratory Required Form for Post Mortem

​You will be redirected to the RRPL Requisition


 Hematology

​Name

​Requisition

​Completion Aid

​Flow Cytometry Requisition
Form #103088
Thrombophilia Investigation (Clotting Disorder)
Form #101521​


HLA

​Name

​Requisition

​Completion Aid

​HLA Deceased Donor Requisition
HLA Test Request Form​
​Platelet Immunology Test Request Form


Microbiology

​Name

​Requisition

​Completion Aid

​Bacteriology/Mycology/TB/ Parasitology Requisition
Form #101063

For parasite testing MUST include:

 

Molecular Microbiology Virology Requisition
Form #101061​
​Patient Sample Information Waiver FAX Form - Saskatchewan Disease Control Laboratory
​Requisition for Viral Zoonoses - National Microbiology Laboratory

Microbiology Requisitions required by Roy Romanow Provincial Laboratory

* Note​: You will find RRPL requisitions under the "Requisitions" section of the linked webpage.

 

Transfusion Medicine

​Name

​Requisition

​Completion Aid

Blood Product and Component Pickup Slip
Form #102930​
Blood Product Request Form
Form #103220​
Plasma Protein Product Request Form (formerly Fractionation Product)
Form #103221​
Transfusion Medicine Test Request Form
Form #101058​

​Canadian Blood Services Request for Perinatal Testing
​Tissue Bank Donor Form
This form should only be used by Transplant and some operating rooms.
​Cellular Therapy Product/Tissue Bank C&S Form
This form should only be used by Transplant and some operating rooms.
​This form must be printed on green paper

​Home Administration Program Product Request Form (formerly Home Infusion Product Requisition)
​Saskatchewan Transfusion Adverse Event Report Form
Form #103695

 

Last Modified: Wednesday, September 4, 2019 |
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