Requisitions

24-hour urine requisition
Item Name: 24-hour urine requisition
Allergen requisition
Item Name: Allergen requisition
Item Description:

Custom Clinical Allergen Requisition

Allergy and asthma requisition
Item Name: Allergy and asthma requisition
Behavioral health requisition
Item Name: Behavioral health requisition
Item Description:

Custom request form for behavioral health facilities

Bone marrow requisition
Item Name: Bone marrow requisition
Item Description:

Bone Marrow Request

Chiropractic requisition
Item Name: Chiropractic requisition
Item Description:

Customized test menu for use by Chiropractic clients

Clinical requisition
Item Name: Clinical requisition
Item Description:

Clinical Requisition

Consultation Center requisition
Item Name: Consultation Center requisition
Item Description:

Consultation Center Request

COVID collection requisition, employee
Item Name: COVID collection requisition, employee
Item Description:

Requisition for requesting COVID testing on employees.

All testing wil be billed back to the requesting facility.

Special Instructions:

Available only for clients who have pre-arranged to have COVID-19 testing performed by Allina Health Laboratory

COVID collection requisition, patient
Item Name: COVID collection requisition, patient
Item Description:

Custom clinical requisition for COVID-19 testing

Special Instructions:

Available only for clients who have pre-arranged to have COVID-19 testing performed by Allina Health Laboratory

CSF requisition
Item Name: CSF requisition
Item Description:

CSF Requisition

Cytogenetics requisition - congenital
Item Name: Cytogenetics requisition - congenital
Item Description:

Cytogenetics Congenital Request

Cytogenetics requisition - oncology
Item Name: Cytogenetics requisition - oncology
Item Description:

Cytogenetics Oncology Request form

Cytology requisition - fine needle aspirate (FNA)
Item Name: Cytology requisition - fine needle aspirate (FNA)
Item Description:

Cytology Fine Needle Aspirate (FNA) Request

Not for order/use by Excellian sites

Cytology requisition - gynecological (cervical/vaginal/pap)
Item Name: Cytology requisition - gynecological (cervical/vaginal/pap)
Item Description:

Cytology Gynecological (Cervical/Vaginal) Request

Cytology requisition - non-gynecological
Item Name: Cytology requisition - non-gynecological
Item Description:

Cytology Non-Gynecological Request

Dermal requisition
Item Name: Dermal requisition
ENT requisition
Item Name: ENT requisition
Eye requisition
Item Name: Eye requisition
Flow cytometry technical and interpretation requisition
Item Name: Flow cytometry technical and interpretation requisition
Item Description:

Requisition to use when requesting Flow cytometry with pathologist interpretation.

Flow cytometry technical only requisition
Item Name: Flow cytometry technical only requisition
Item Description:

Flow Request

Gastroenterology requisition
Item Name: Gastroenterology requisition
Hematology smear QA review requisition
Item Name: Hematology smear QA review requisition
Histopathology add-on requisition
Item Name: Histopathology add-on requisition
Item Description:

Pathology Add-on Request Form

Histopathology requisition - 12 pt prostate biopsy
Item Name: Histopathology requisition - 12 pt prostate biopsy
Item Description:

Hisopathology 12 Pt Prostate Biopsy Request

Histopathology requisition - Breast
Item Name: Histopathology requisition - Breast
Item Description:

Pathology Tissue Exam, Breast Request

Histopathology requisition - gastrointestinal
Item Name: Histopathology requisition - gastrointestinal
Histopathology requisition - Placenta
Item Name: Histopathology requisition - Placenta
Item Description:

Pathology Tissue Exam, Placenta Request

Histopathology requisition - Processing & special stains
Item Name: Histopathology requisition - Processing & special stains
Item Description:

Histology Processing & Special Stains Requisition

Histopathology requisition - Skin lesions
Item Name: Histopathology requisition - Skin lesions
Item Description:

 

 

Histopathology requisition - Tissue exam
Item Name: Histopathology requisition - Tissue exam
Item Description:

Histopathology Tissue Exam Requisition

HomeCare/nursing facility requisition
Item Name: HomeCare/nursing facility requisition
Item Description:

Custom request forms for HomeCare and Nursing facility clients

Hospital downtime requisition
Item Name: Hospital downtime requisition
Immunohistochemistry (IHC) and ISH requisition
Item Name: Immunohistochemistry (IHC) and ISH requisition
Item Description:

Immunohistochemistry Request

Infectious disease requisition
Item Name: Infectious disease requisition
Item Description:

Infectious disease specific testing request form

Kleihauer (Fetal cell) requisition
Item Name: Kleihauer (Fetal cell) requisition
Microbiology requisition
Item Name: Microbiology requisition
Molecular requisition
Item Name: Molecular requisition
Item Description:

Molecular Request

Neurology requisition
Item Name: Neurology requisition
Obstetric test requisition
Item Name: Obstetric test requisition
Occ Health requisition - comprehensive (non-Allina Health)
Item Name: Occ Health requisition - comprehensive (non-Allina Health)
Occ Health requisition - exposure (Allina Health)
Item Name: Occ Health requisition - exposure (Allina Health)
Occ Health requisition - exposure (non-Allina Health)
Item Name: Occ Health requisition - exposure (non-Allina Health)
Occ Health requisition - QFT (non-Allina Health)
Item Name: Occ Health requisition - QFT (non-Allina Health)
Occ Health requisition - volunteer/new employee screening
Item Name: Occ Health requisition - volunteer/new employee screening
Ocular/vitreous referral testing requisition
Item Name: Ocular/vitreous referral testing requisition
Ophthalmology requisition
Item Name: Ophthalmology requisition
Item Description:

Custom clinical ophthalmology requsition for bloodwork

Paraneoplastic/autoimmune CSF requisition
Item Name: Paraneoplastic/autoimmune CSF requisition
Item Description:

Paraneoplastic/autoimmune CSF requisition

All testing wil be billed back to the requesting facility.

Peripheral morphology requisition
Item Name: Peripheral morphology requisition
Item Description:

Request form for peripheral blood morphology examination

Reproductive medicine requisition
Item Name: Reproductive medicine requisition
Surgery center requisition
Item Name: Surgery center requisition
Synovial/joint/body fluid analysis requisition
Item Name: Synovial/joint/body fluid analysis requisition
Urology requisition
Item Name: Urology requisition
Item Description:

Customized test menu for use by Urology clients