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Labs, imaging and referrals Illustrative patient · real sheet

It is written
before they stand up.

In most clinics a requisition is a note on a pad that somebody types up later, or a form the patient has to come back for. Here it exists, numbered and ready to print, while they are still in the chair.

Bow Valley Family Practice

1402 Kensington Rd NW, Calgary, Canada

reception@bowvalleyfp.ca

Laboratory requisition

Ref QORD-000417

Ordered Aug 21, 2026

Routine

Patient

Name
Marco Delgado
Date of birth
Mar 14, 1978
Health card (PHN)
81234‑5678
Qlynic ID
QLY‑4471
Phone
(403) 555‑0148

Requested

Morning bloodwork — fatigue, 3 months

CBC with differential

TSH

Ferritin

Ordering provider

Provider
Dr. Amelia Chen  ·  Family Medicine
Clinic
Bow Valley Family Practice
Provider signature Date

Bow Valley Family Practice  ·  1402 Kensington Rd NW, Calgary
Ref QORD-000417 · Generated by Qlynic

What the doctor did

One line.

Everything above it — the name, the date of birth, the health card number, the phone, the clinic, the provider — was already in the record. The sheet fills itself out of what you already know, and the doctor writes the part only a doctor can write.

Anything the record does not have prints as a blank writable line rather than a gap, so the sheet is never unusable — a patient with no health card on file still walks out with something the lab will accept.

  • QORD-000417 Its own reference number — printed on the sheet, repeated in the footer, and used to name the file you download.
  • Routine · Urgent · Stat Printed as a pill in the top right corner, where whoever picks the sheet up will see it before anything else.
  • Print or download The patient can walk out of the room holding it, which is the entire point of writing it in the room.