Diagnostic

Requisitions for submitting specimens are listed below. These must be used and filled in completely according to PHSA Laboratories policy. Inappropriate requisitions will be followed up by a Quality Specialist.

The requistions below are all in PDF format - print the form you need and fill it in according to the instructions. Please pay special attention to the guidelines for how, where and when to ship samples.


New Requisitions Now Available! In an effort to continue to provide quality service, we have consolidated and digitalized many of our requisitions. Most of the requisitons below can be filled in digitally and printed for your convenience. Please begin to use these requisitions immediately for your testing needs

Requisition	Testing Information
Bacteriology & Mycology Requisition	Bacteriology & Mycology Program information Sample collection instructions Pertussis collection instructions Enteric Bacteriology diseases & infections Non-enteric Bacteriology diseases & infections Mycology Fungal diseases & infections
Food Poisoning Investigation   Part A: Incident Summary Part B: Requisition	Food Poisoning & GI Investigation program information Sample collection information Environmental Microbiology Diseases & Infections (Foodborne)
GI Outbreak Requisition	Note: New requirements for GI Outbreak notification process and requisitions. Food Poisoning & GI Investigation program information Outbreak Investigations
GI Outbreak Notification	Note: New requirements for GI Outbreak notification process and requisitions. For GI outbreaks in an institution/facility or during an event/function.
Influenza Like Illness (ILI) Outbreak Form	For ILI outbreaks in an institution/facility.
Mycobacteriology/TB Requisition	Mycobacteriology/TB Program information Sample collection instructions Mycobacteriology diseases & infections
Parasitology Requisition	Parasitology Program information Sample collection instructions Parasitology diseases & infections
Pulse Field Gel Electrophoresis Approval (PFGE)	Bacteriology & Mycology Program information Sample collection instructions
Serology Screening Requisition	Virology Program information
Virology Requisition	Virology Program information Sample collection instructions Virology diseases & infections    Note: Use for Influenza testing
Zoonotic & Emerging Pathogens Requisition	Zoonotic Diseases & Emerging Pathogens Program (ZEP) information Sample collection instructions ZEP Bacterial diseases & infections ZEP Fungal diseases & infections  ZEP Parasitic diseases & infections ZEP Zoonotic diseases & infections
Sample Container Order Form	Collection Kit information