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Molecular Hematology Requisition

Demographic and Test Order Information

Specimens must be accompanied by requisitions with complete Demographic and Test Order Information.

Additional Information

Molecular Hematology requisitions should be used to avoid delays in specimen transport. To assist the laboratory in proper sample processing and interpretation of results, include clinical diagnosis and transplant/treatment history for specimens requiring molecular analysis.
For hemostasis and thrombosis gene studies, include a clinical diagnosis and a personal and/or family history.
Check off the test requested in the appropriate box(es). Refer to requisition for ordering guidelines for molecular studies.

Any questions related to testing provided by Molecular Hematology, call 403-770-3699 extension 2.

Requisitions are available on the CLS website: Molecular Hematology requisition (REQ9053MH).