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Standardized Provincial Anatomical Pathology Request Form

January 04 , 2018

Key Message:

  • A standardized Anatomical Pathology request form has been implemented provincially to replace the variety of versions previously in use across the province.
  • The new provincial Anatomical Pathology Requisition is to be used only for tissue samples.
  • A new Edmonton Zone form: Nongynecologic Cytopathology Requisition has been created to be used for nongynecologic cytology sample (fluid samples).


  • any specialty requisitions/forms that contain diagrams of organs (i.e. endoscopic requisitions, gastrointestinal requisitions, breast requistions, etc.) will not be replaced. Continue using current specialty requisitions/forms.
  • DynaLIFE forms will not be replaced. Continue using current DynaLIFE forms.

Both, the provincial Anatomical Pathology Requisition and Edmonton Zone Nongynecologic Cytopathology Requisition are currently available for use. Please transition to using these forms as soon as possible.

Why this is important:

  • The new Anatomical Pathology requisition is expected to assist with decreasing delays and quality concerns that occur as a result of incomplete/incorrect information on the current Anatomical Pathology/Histology test request.
  • A standardized provincial AP request form will mitigate the risk of sample identification errors.

Action Required: the new forms are now available as follows:

New Form Used for Form Number Web link Replacing
Anatomical Pathology Requisition tissue samples 19027(Rev2017-05) click here Cytopathology/ Tissue Requisition CH-0023
Nongynecologic Cytopathology Requisition Nongynecologic cytology samples 20984(2017-09) click here


Print Access: AHS facilities can access the print version through their usual ordering processes:

  • Data CM (For AHS Staff not registered as users - self register at this web address for account set-up. If you have questions or require further assistance with the online order system contact the AHS Help Desk at DATA CM. at P: 403.207.6631 or

For any non-AHS agencies: If you are not registered as a user please contact to request the online set-up form. A credit card will be required for each online purchase. 
For implementation of the form in physician clinic EMR systems: please have your vendor contact and the Forms Program will provide assistance.

If you need more information or assistance with getting access to the form, contact

  • Physician/Requestor(s) MUST complete following sections on the FRONT page, following the Acceptance of Laboratory Samples and Test Requests provincial policy:
    • Patient Demographics
    • Requestor(s) Information
    • Collection information
    • Clinical Information, including:
      • Current Problem(s) / Differential Diagnosis
      • Relevant Family / Past Medical History
      • Additional Information
    • Sample / Tissue(s) description
  • Review the Requisition Requirements job aid
  • ONLY Laboratory staff will complete all applicable sections on the BACK of the form.

Additional Information:
The AHS Test Directory for Edmonton Zone anatomical pathology and cytopathology samples has been updated. Access the AHS website for information on the following tests:

Anatomical Pathology Cytopathology
  • Routine Surgical Specimens
  • Intraoperative Consult (Frozen Section)
  • Immunofluorescence
  • Cardiac Biopsy - Native
  • Cardiac Biopsy - Transplant
  • Muscle Biopsy
  • Nerve Biopsy
  • Electron Microscopy
  • Kidney Biopsy - Native
  • Kidney Biopsy - Transplant
  • Kidney Biopsy - Baseline / Donor
  • Aspirated cyst fluid
  • Bronchial Brushings
  • Bronchioaveolar lavage BAL
  • Cerebral Spinal Fluid CSF
  • Cytodiagnostic Urinalysis
  • Fine Needle Aspirate Clinic
  • Fine Need Aspirate FNA
  • Serous Fluids
  • Sputum
  • Urine for Cytology


Inquiries and feedback may be directed to:

  • Site Anatomical Pathology Tech IIs
  • Robin Stocks - EZ Anatomical Pathology Quality Assurance Tech II
  • Jenny Zadunayski - Provincial Anatomical Pathology Coordinator

This bulletin has been reviewed and approved by:

  • Dr. Michael Mengel, Zone Clinical Department Head, Laboratory Services Edmonton Zone

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