Alberta Initial Screening Serology Requisitions
This set of three pre-filled requisition forms from the Migration Humanitarian Health Collective (MH2C) is designed specifically for Alberta physicians conducting initial screening of refugee patients.
FORM 1 - SEROLOGY AND MOLECULAR TESTING REQUISITION Current PDF (to be re-hosted): https://irp-cdn.multiscreensite.com/3e1201a4/files/uploaded/ProvLabSerologyRequisitionFillable.pdf Instructions for clinicians: Complete the Clinical History section. Check: Syphilis serology (adults only). Check: Varicella zoster IgG (patients over 13 years). Add Schistosoma serology under "Specify Other Serology and Molecular Tests" for patients from an endemic country.
FORM 2 - COMMUNITY GENERAL REQUISITION Current PDF (to be re-hosted): https://irp-cdn.multiscreensite.com/3e1201a4/files/uploaded/Community%20General%20Requisition%20-%20All%20Patients%20-%20Fillable%20Fields.pdf Instructions for clinicians: Check Hemoglobin A1c for adults over 35 or positive family history of diabetes. Add G6PD levels under "Other Tests Not Listed" for male patients only.
FORM 3 - MICROBIOLOGY REQUISITION Current PDF (to be re-hosted): https://irp-cdn.multiscreensite.com/3e1201a4/files/uploaded/Microbiology%20Requisition%20-%20Fillable.pdf Instructions for clinicians: For adults only. No specific additional checkboxes required.
References
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