MUHC Laboratory Requisitions and consultations

COVID-19

DM-6310 COVID-19 External requisition for testing done outside hospital setting (2020-06-11)

DM-6311 COVID-19 Adult Internal requisition - Hospital settings only (revised 2021-02-05)

DM-6329 COVID-19 MCH Internal requisition - Hospital settings only (revised 2021-02-05) Print on pink paper

DM-6333 COVID-19 Lachine Internal requisition - Hospital settings only (revised 2021-03-04)

 

Authorization for testing not available in Québec (AH-612 form)

Print and complete

Complete On-line and Print

 

Biochemical Genetics

DM-3344 Biochemical Genetic requisition (revised 2020-12-18)

 

Central lab / Serology / ARV

DM-2747 ARV: Data collection form for antiretroviral therapeutic drug monitoring (revised 2016-12-22)

DM-3114 Central laboratory (Montreal General hospital only): Requisition for STAT requests (version 2017-07-10)

DM-3165 Central laboratory: Requisition for internal patients (adults) - (revised 2016-08-22)

DM-3172 Central laboratory: Requisition for internal patients (children) (revised 2016-08-02)

DM-5003 Laboratoires - Rapid response requisition (Lachine Campus only) (revised 2016-02-25)

DM-5502 Laboratories: Requisition for external patients (revised 2016-03-31)

 

CMDL (Core Molecular diagnostic Lab)

DM-4632 Molecular Diagnostics requisition (version 2016-07-14)

DM-5891 Molecular Genetics requisition (version 2020-01-22)

DM-4766 Informed consent form for Molecular Genetic testing (version 2015-11-11)

DPYD Genotyping instructions (2020-01-22)

 

Cytogenetics

Requisitions

DM-5834 Cytogenetics requisition Prenatal analysis (revised 2018-07-13)

DM-5835 Cytogenetics requisition Postnatal analysis (revised 2018-07-13)

DM-5836 Cytogenetics requisition Tissue FISH (revised 2018-07-13)

DM-5885 Cytogenetics requisition Postnatal Chromosomal SNP Microarray (2019-11-11)

Consent forms

DM-6148 Chromosomal SNP Microarray test: Information and Consent form for the pediatric population (2020-01-06)

DM-6150 Chromosomal SNP Microarray test: Information and Consent form for adults (2019-12-19)

Information for karyotype and FISH testing

Summary for karyotype and FISH testing of adult hematology-oncology specimens (revised 2018-08-07)

 

Histocompatibility and Immunogenetics Laboratory (HLA)

DM-4606 Tissue typing laboratory (HLA) (revised 2016-03-16)

 

Microbiology  (Requisitions for tests referred out to external labs)

B-D-Glucane CHUL Requisition (revised  2018 08 16)

Bacterial identification by 16S rRNA LSPQ Requisition (version: V03)

Pneumocystis jirovecii detection by PCR LSPQ Requisition (revised 2019 06)

Human papilloma virus  (HR HPV) detection CHUM, CHUL Requisition (revised 2016 03 29)

 

Microbiology/ Parasitology/ Malaria/ Lyme disease

DM-3103 Parasitology (revised 2018-07-13) - Guide on how to complete requisition

DM-3166 Microbiology requisition (revised 2019-10-22) (Guide on how to complete requisition)

DM-5302 Microbiology requisition for Lyme disease (2019-10-24)

DM-5602 Malaria Reference Service requisition (revised 2017 02 07)

 

Pathology / Cytopathology

DM-3111 Pathology consultation (Requisition) (revised 2016-03-16)

DM-4637 Request for kidney allograft biopsy (version 2018-01-30) 

DM-5047 Cytopathology non gynecological requisition (revised 2016-09-20)

DM-5049 Cytopathology gynecological requisition (revised 2016-05-25)

DM-5811 Immunohistochemistry requisition (version 2017-06-16)

DM-5824 Request for placental examination (requisition) (version 2017-12-21)

 

Transfusion services

DM-3472 Services transfusionnels (revised 2016-03-07)