Clearly mark the tests you want and include special information, such as the number of hours fasting, medications and last dose on the requisition form. Cytology Requisition Form; Laboratory Forms and Requisitions. Research - Programs and Projects. Staff. Contact Us. 600 University Avenue Toronto, Ontario, M5G 1X5 LTD Specimen Labeling/Request Form Completion Version 6. Specimen Labeling and Request Form Completion. Purpose: The purpose of this policy is to describe the process of labeling laboratory.

Laboratory requisition form

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Genetic Testing Download to Print This Form. PGX Download to Print This Form. Infectious Disease Download to Print This Form. Toxicology Form Download to Print This Form. Phlebotomy Form Download to Print This Form.

Appointment Alberta Precision Laboratories 1- 877-868-6848 Important - Form is used for regular and downtime use.

Order Supplies. Laboratory Supply Order SARS-CoV-2 Laboratory Requisition and PUI Evaluation Form . Asymptomatic individuals Will NOT be tested .

Laboratory requisition form

Laboratory requisition form

Incomplete or illegible requisitions will delay the return of results.

Laboratory requisition form

FAX Request for Test Results (fillable pdf) Healthcare providers only, not for patient use. Influenza Virus Collection Protocol Influenza Test Requisition. Laboratory Requisition Form Printable Lab Requisition Fillable.
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Laboratory requisition form

The information on this form must match the specimen tube exactly. For  General Laboratory Requisition (All Zones); Gynecological Cytopathology Edmonton Zone Immunohistochemistry Request Form, Anatomical Pathology  TELEPHONE REQUISITION RECEIVED BY: (employee/date/time).

slip which contains the same two patient identifiers used to identify the patient. and the information as detailed in the section of the request form.
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Please indicate Molecular Diagnosis/PCR on the form. Includes: Campylobacter spp., E. coli, Shigella spp., and Yersina spp., Bordetella pertussis, Corynebacterium diphtheria, Beta Streptococcus, and Group A Streptococcus. Order Supplies.

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to build ordering codes and test (result) codes into your laboratory information system ( LIS). MEDICAL NECESSITY: You should only order laboratory tests that are reasonable and medically necessary for your patient. Upon request, you must be able to  Please include a completed requisition with each patient sample referred to the Diagnostic Laboratories.

Chemistry. Chemistry, Chemistry Specialty. Edmonton. COVID-19 Test Requisition Form - 21597. Public Health Ontario.

Non-gynecologic Cytology Requisition and Service Record Cytology -051. Reference Laboratories Requisition. Surgical Pathology Requisition General Laboratory Requisition Appointment Booking & Locations: www.dynalife.ca or www.albertaprecisionlabs.ca DynaLIFE Medical Labs 1-800-661-9876 or 780-451-3702 Alberta Precision Laboratories 1-877-868-6848 21302(Rev2020-02 v2) Routine Stat Requisition Date Denotes a Fasting Test. Refer to Patient Instruction Sheet. Hours Fasting _____ Renal Diagnostics Test Request Form (T830) Therapeutics Test Request Form (T831) Whole Exome Sequencing Test Request Form (T801) If none of those tests apply, use the General Test Request Form (T239) After completing and printing, send the form with your specimens to Mayo Clinic Laboratories. Requisition Forms.