Home
Forms Library
4422 84 (07 06) - Ontario - health gov on

4422 84 (07 06) - Ontario - health gov on-2025

4422 84 (07 06) - Ontario - health gov on Preview on Page 1

Show details

4.7 out of 5

62 votes

The document is a laboratory requisition form from the Ministry of Health and Long-Term Care, designed for clinicians to request various medical tests for patients. It includes sections for clinician and patient information, test selection (such as biochemistry, hematology, immunology), and additional clinical details. The form emphasizes the need for separate requisitions for specific types of tests and requires clinician certification that the tests are not for hospital inpatients.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to edit 4422 84 (07 06) - Ontario - health gov on in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Adjusting documents with our feature-rich and intuitive PDF editor is straightforward. Follow the instructions below to complete 4422 84 (07 06) - Ontario - health gov on online quickly and easily:

Sign in to your account. Log in with your email and password or create a free account to try the product prior to choosing the subscription.
Import a form. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit 4422 84 (07 06) - Ontario - health gov on. Effortlessly add and highlight text, insert images, checkmarks, and symbols, drop new fillable fields, and rearrange or delete pages from your document.
Get the 4422 84 (07 06) - Ontario - health gov on accomplished. Download your updated document, export it to the cloud, print it from the editor, or share it with others via a Shareable link or as an email attachment.

Make the most of DocHub, the most straightforward editor to quickly handle your paperwork online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to read a phlebotomy requisition form?

The essential elements of the requisition form are: Patients surname, first name, and middle initial. Patients ID number. Patients date of birth and gender. Requesting physicians complete name. Source of specimen. Date and time of collection. Initials of phlebotomist. Indicating the test(s) requested.

How to read a lab requisition form?

Requisition forms, sometimes called referral forms, are used by your doctor or local physician to communicate precisely what type of exam you require for a medical assessment. These forms direct our technologists by outlining where diagnostic imaging is needed, such as your left shoulder or right ankle.

How to read a requisition?

Purchase requisition forms usually comprise the following details: Name and division of the requestor. The goods or services requested. The date of request. The legal name of the vendor. Item description, price, and quantity. Purchase purpose.

What lab values would indicate infection?

Common Infection Indicators in Blood Tests Elevated White Blood Cell Count. A high WBC count (leukocytosis) often indicates infection. Increased Neutrophil Count (Neutrophilia) Lymphocytosis. Elevated C-reactive Protein (CRP) High Erythrocyte Sedimentation Rate (ESR)

What information is found on a requisition form?

The test requisition combines patient registration information, billing information, specimen information, barcoded specimen labels and a provider order for confirmation of testing. The patient bill requisition should be completed by the provider or authorized staff and signed by the ordering provider.

How long do requisitions last in Ontario?

All patient specimens must be accompanied by a fully completed, signed requisition form. For patient safety, each Laboratory Requisition is only valid for 6 months after the date that it was authorized. The Ontario Ministry of Health and Long Term Care Requisition Form.

Do lab papers expire?

Most laboratory results are valid for only a certain time period (laboratory tests shelf-life), after which they are outdated and the test needs to be re-administered.

4422 84 (07 06) - Ontario - health gov on-2025

Here's how it works