Download requisition for abo blood typing

KIDNEY LIVING DONOR PROGRAM
6A – 1081 Burrard Street
Vancouver, BC V6Z 1Y6
Phone: 604-806-8970 Fax: 604-806-9873
REQUISITION FOR ABO-A BLOOD SUBTYPING
NAME:
DOB:
PHN:
DIAGNOSIS:
Potential Kidney Donor
ORDERING PHYSICIAN: Dr. John Gill, MD (26258)
BLOOD REQUIRED:
7 mls EDTA (purple top tube)
TEST REQUIRED:
ABO Blood type.
If identified as Type "A"
Please subtype to determine A1 or A2.
Do not crossmatch
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MAILING INSTRUCTIONS:
If local lab does not charge patient for this, result locally and forward results.
If you must charge patient, send sample refrigerated to St. Paul’s Hospital as instructed below.
1.
Label specimen with patient's name, birth date, date and time of
collection. Include this form with the specimen.
2.
Send to:
St. Paul’s Hospital
Transfusion Medicine Lab (Blood Bank)
1081 Burrard Street
Vancouver, BC
V6Z 1Y6
604-806-8003
Fed Ex/ BCTS 1343 78646 (3rd Party Billing / 73501557- SPH)
If there are questions please call 604-806-9027, or 604-806-9944
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Send report to Fax: 604-806-9873 (Pre Renal Transplant Donor, 6A, room 6006)
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