Completing the Requisition

Correct, complete clinical, test and demographic information is required on all requisitions.  The requisition must be legible and completed in indelible ink.  Incomplete information results in delays, difficulty in reporting or possible rejection.  If the test is not in the Alphabetical Test Directory contact the lab for consultation.  The following minimum demographic and test order information must be included on all requisitions.   

Demographic and Test Order Information

Patient Name: Print patient's legal name legibly, LAST name first followed by FIRST name and MIDDLE initial.  Please use legal first name.

Personal Health Number: Provide patient's Personal Health Number or other billing information.  For patients who wish to maintain billing confidentiality and prevent a laboratory encounter from appearing on their Alberta Health Care statement, indicate "Suppression of Claim" here; DO NOT indicate patient's PHN.

Confidential Patient Information: In special circumstances, to maintain a higher level of confidentiality, patient identity may be protected by using a code name/number instead of the patient's name.  Assign a code name/number that is unique to the patient.  You will need to maintain a record of assigned patient codes.  The code you provide is the only identifying patient information that will appear on the laboratory report.  DO NOT indicate the patient's PHN or other billing information.

Patient Address and Phone Number: Patient phone number is required for community patients.  Patient address is not required for patients with a valid Alberta PHN.  Addresses with postal code must be included for all out-of-province patients and in cases where patients are paying for their tests.

Chart Number: Enter the chart number, if applicable.

Gender & Date of Birth: Many reference ranges are determined by patient gender and/or age.

Tests Ordered: One requisition may be used to order multiple tests.  Certain divisions/tests require specific requisitions.

Specimen Source & Patient History: Indicate specific source and/or site plus patient history.

Date & Time of Collection: Date and time must be recorded as well as the name or initials of the collector.

Specimen Priority: Indicate specimen priority for each test.

Referring (Ordering) Physician: Indicate the name and location of the ordering physician.  Community physicians are provided with a stamp.  For further information on the importance of the stamp or how to request new or modified stamps, see the Information for Physician and Healthcare Professionals section Ordering Information.  When a stamp is not available for use, please provide the physician's surname with the first name and address for report delivery and physician's client (College) number.

Copy To Physician: When requesting additional report copies please provide the first and last name of the 'copy to' physician or the name and fax number for the intended fax 'copy to' physician.  If an office location is not provided for the 'copy to' physician, and he/she has multiple locations, the report will be directed to a default location for that physician.