Alberta Precision Laboratories' provincial community requisition for routine blood work and common tests, from CBC and chemistry to serology, drug levels, urine tests, Framingham risk assessment and FIT. Community prescribers use it when ordering outside Connect Care; APL lists it, with Connect Care generated orders and specialty requisitions, as an approved way to order. The current revision is 21302 (Rev2026-09).
The authorizing provider, who orders the tests and acts on the results, completes the patient and provider blocks, copy-to recipients, tests and clinical information. The collector completes the collection date, time, location and collector ID.
Download the current version from the source each time; forms change without notice.
General Laboratory Requisition
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Yes. APL's guidance on completing requisitions says patients who want billing confidentiality can have 'Suppression of Claim' written in the identifier field, and the PHN is then left off. A phone number is still required for community patients, and an address is needed for out-of-province patients and those paying for their own tests.
The Cardiovascular Disease Risk Assessment box includes a lipid panel and requires history: systolic blood pressure, plus yes or no answers for current tobacco use, treatment for high blood pressure, diabetes, chronic kidney disease, atherosclerosis, and a first-degree relative with cardiovascular disease (male under 55, female under 65).
F marks a fasting test, with a box for hours fasting, and I points to a patient instruction sheet. Fasting glucose and the 2-hour glucose tolerance tests carry both symbols. Timed 24-hour urine collections carry I and need the start and end dates and times and the total volume recorded.