LifeLabs will continue to process all FIT requisitions received as fast as possible. 1. 0000052379 00000 n This information is considered confidential. 0000244814 00000 n 0000236338 00000 n requisition. FORM for Life Labs CEA TESTING under OHIP This form must be signed by the physician for a CARCINOEMBRYONIC ANTIGEN test or the patient will be required to pay for the testing. 0000006761 00000 n first . 0000231808 00000 n endstream endobj startxref 10.0 Current Issue Date: 04-Apr-2018 Page 1 of 3 The minimum amount of patient information is collected for provision of the service requested. 0000249072 00000 n 0000229013 00000 n If you are consulting via phone / virtually, you can email a PDF of the requisition form. Private Pay Requisition. 0000242585 00000 n I acknowledge that LifeLabs will send the results to my ordering healthcare provider and other providers involved in my care. 0000230067 00000 n 1. LifeLabs will refund the amount which you paid for your test if LifeLabs is unable to deliver a result within 48 hours after your sample collection. CYTOLOGY & HPV TESTING REQUISITION GYNECOLOGIC CYTOLOGY (PAP TEST) HPV TESTING HPV testing can be ordered, at the patient’s request, on the same sample that is submitted for a Pap test HPV testing can be useful in the management of women over the age of 30. 0000240514 00000 n 740 0 obj <>stream 0000164591 00000 n Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. I understand that 1 blood ... LifeLabs Genetics complies with Canadian privacy rules. Start a free trial now to save yourself time and money! For questions, contact the LifeLabs Genetics Team email: Ask.Genetics@LifeLabs.com or call 1-84-GENE-HELP (1-844-363-4357) The personal information collected on this form, and any medical data subsequently developed, will be handled in compliance with … 0000246481 00000 n LifeLabs, hospital outpatient labs). 0000231757 00000 n %%EOF 0000145663 00000 n 0000053763 00000 n information please call LifeLabs, Customer Care Centre at 1-877-849-3637. CYTOLOGY & HPV TESTING REQUISITION Inadequate clinical information may hinder diagnosis. 0000025009 00000 n 0000246586 00000 n 0000248468 00000 n 0000248157 00000 n 0000247374 00000 n All sections on this form must be accurate and complete. GYNECOLOGIC CYTOLOGY (PAP TEST) HPV TESTING NON-GYNECOLOGIC CYTOLOGY OHIP/Insured Third Party/Uninsured WSIB Specimen Collection Date: # of Specimens Submitted # of Slides … 0000249793 00000 n 1-844-363-4357. Lifelabs Panorama NIPT 2019. Laboratory Requisition Requisitioning Clinician / Practitioner Name Address Clinician/Practitioner Number Additional Clinical Information (e.g. Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. completed requisition form . Complete the lab requisition portion FIRST (pages 1-5) including fillable-PDF fields for doctor, office, test code, test name, as well as patient information. Ensure all other fields of the funding form are completed (clinical diagnosis, etc. I have read the Patient Information Form (on reverse). 0000099292 00000 n 0000250403 00000 n OAHPP collection of personal health information on this form is collected under the authority of the Personal Health Information Protection Act, s.36 (1)(c)(iii). For reports status inquiries contact LifeLabs Customer Care Cen. 0000052116 00000 n OHIP Requisition Essential Information QRA Oct 2013 MOHTLC Requisition Essential Information To be completed fully and clearly by Client and Phlebotomist 0000246707 00000 n 0000241284 00000 n 0000243097 00000 n endstream endobj 502 0 obj <>/Metadata 15 0 R/PageLabels 497 0 R/Pages 499 0 R/StructTreeRoot 28 0 R/Type/Catalog/ViewerPreferences<>>> endobj 503 0 obj <. 0000053018 00000 n 0000228904 00000 n 0000242981 00000 n As COVID-19 continues on, many airlines or countries now ask for proof of COVID-19 clearance within a specific timeframe or window. Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. 0000241447 00000 n Requester Type (check one): Physician. 0000010777 00000 n For results interpretation inquiries, please call: 416-675-4530 Ext. According to Public Health Ontario, serology testing should not be used for the … 0000229467 00000 n 0000073541 00000 n Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. 501 0 obj <> endobj 0000248274 00000 n It is for the use of authorized health care providers only. 0000241369 00000 n All information entered above will then be automatically entered into MOH funding application form. Ministry Or Health And Long Term Care Lab Requisition. 0000247452 00000 n ). 198 0 obj <> endobj xref 198 151 0000000016 00000 n 0000248091 00000 n Ask.Genetics@LifeLabs.com May 2018_v6 Page 1/8 The minimum amount of patient information is collected for provision of the service requested. 644 0 obj <>/Filter/FlateDecode/ID[<0D3435E5C6D9AD4D90A5084BE7EE42EC>]/Index[501 240]/Info 500 0 R/Length 302/Prev 283606/Root 502 0 R/Size 741/Type/XRef/W[1 3 1]>>stream 1-844-363-4357. 0000003723 00000 n 0000236731 00000 n 0000246902 00000 n In the event of a high risk or no result, I acknowledge that LifeLabs may contact All sections on this form must be accurate and complete. diagnosis) Note: Separate requisitions are required for cytology, histology / pathology, ColonCancerCheck FIT test, and tests performed by Public Health Laboratory Patient’s Last Name (as per OHIP Card) 0000221186 00000 n 0000018546 00000 n 0000122098 00000 n LifeLabs. 1-844-363-4357 Ask.Genetics@LifeLabs.com Appointment booking can be done at www.lifelabs.com GENETICS NATIONAL PANORAMA PRIVATE PAY REQUISITION Doc #24488 Ver. 0 For technical inquires contact Flow Cytometry at: 416-675-4530 Ext. 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