Requisitions

Edmonton Zone

Requisition	Completion Aids
General Requisition — Edmonton	General Requisition Completion Aid
AP Requisition — New	AP Requisition Completion Aid — New
Dermatopathology Requisition — New	Dermatopathology Requisition Completion Aid — New
Gyne Requisition — New	Gyne Requisition Completion Aid — New
Non Gyne Requisition — New	Non Gyne Requisition Completion Aid — New
Home Collections Requisition — New	General Requisition Completion Aid
Microbiology Requisition — Edmonton — New	Microbiology Requisition Completition Aid — New
Regional Blood Transfusion Requisition
Vitamin D requisition

Harmony Kit Information - All documents below are required

Dynacare Harmony Kit Requisition

Dynacare Harmony Kit Patient Authorization Form

DynaLIFE 3rd Party Harmony Kit Requisition

Complete Patient Care Centre Information

Complete Patient Instructions

Outside Edmonton Zone — Specimens sent to DynaLIFE

(See Completion Aids Above)

General Requisition — DynaLIFE

AP Requisition — New

Dermatopathology Requisition — New

Gyne Requisition — New

Non Gyne Requisition — New

Microbiology requisition — DynaLIFE — New

Vitamin D requisition

Complete Patient Care Centre Information

Complete Patient Instructions

Speciality Requisitions — AHS Edmonton Zone

Chemistry Specialty Requisition — AHS Edmonton

Chromosomal Microarray Requisition — AHS North and South cytogenetics laboratories

Genetics Requisition

Hematology Specialty Requisition — AHS Edmonton

Histocompatibility Requisition — AHS Edmonton

Maternal Prenatal Screen Requisition — AHS Edmonton

Molecular Diagnostic Requisition — AHS Edmonton

Molecular Pathology Requisition — AHS Edmonton

Semen Analysis Requisition — AHS Edmonton

Provincial Laboratory Requisitions - North

Culture and Serology Requisition — Provincial Laboratory North

Zoonotic serology requisition

Provincial Prenatal Program Requisitions

Prenatal Testing — Initial Screen for Pregnant Women

2-part requisition can be ordered from:
Government of Alberta on-line forms and publications ordering
(Use form HS0001-133 (Prenatal testing — Initial Screening for Pregnant Women)

Prenatal Testing — Universal Syphilis Retesting

Perinatal Follow-up Testing for Red Blood Cell Serology

Printed:

This printed copy may not contain the most current information, visit www.dynalifedx.com for the latest information.