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This form is used by clinicians and practitioners to requisition laboratory tests for patients.
The form requires detailed patient information including name, address, health number, date of birth, and contact numbers.
Clinicians must specify the service date when ordering tests to ensure timely processing.
The form includes various test categories such as Biochemistry, Hematology, Immunology, Microbiology, and more.
The form distinguishes between insured patients who meet OHIP eligibility criteria and uninsured patients who are responsible for payment.
Separate requisitions are required for cytology, histology/pathology tests and those performed by Public Health Laboratories.
Clinicians must certify that the tests ordered are not for registered in or outpatients of a hospital.