lifelabs requisition form

Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. • Mail it or drop it off at the nearest LifeLabs location within 10 days of collecting your . GYNECOLOGIC CYTOLOGY (PAP TEST) HPV TESTING NON-GYNECOLOGIC CYTOLOGY OHIP/Insured Third Party/Uninsured WSIB Specimen Collection Date: # of Specimens Submitted # of Slides … Lifelabs Panorama NIPT 2019 - Read More… 0000025009 00000 n LifeLabs. 0000221186 00000 n 0000003723 00000 n 0000229665 00000 n 0000233793 00000 n 0000098652 00000 n 0000240975 00000 n 0000052116 00000 n Patients can then visit a LifeLabs patient service centre (PSC) to get a blood sample collected, and pay for the COVID-19 antibody test. 0000229013 00000 n 0000229123 00000 n LifeLabs will only report test results to the ordering healthcare provider(s) or 0000018546 00000 n Call LifeLabs for questions: 1-833-676-1426. For accurate and timely cytologic diagnosis, provide all information required. 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. 0000006168 00000 n LifeLabs locations across Ontario and LifeLabs requisition form (payment is required first). 740 0 obj <>stream 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. Call LifeLabs for questions: 1-833-676-1426 1. 0000024895 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). 0000247452 00000 n 0000245847 00000 n 0000023075 00000 n 0000233611 00000 n 0000241447 00000 n 0000249793 00000 n 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) o*���v>�n�_��&�-{��OoYҫ�e�`�`�}P}D�A�2�[Ȫ��}�O;�M�Ə��5���������뉆���U=��b�cϟ���׉��믷7��������Ǜ�'8%�bW'aǏ_ٛ $Տ/��?���ǖ'� Tg�����Q�;��C���s��y>~�p�ǧۛ��G�N۶�B���U�&*��*�ݞ��ؕV���V� Ys�R��$�� ���n.R��H�8�A9�E��I�x�y�����y���e�8V��L%Ј�8e�I�e^���~�7�;�^��w��U�'B�.�S{�����ڤ��Y’c�R�v� �r�rͧ4��du�W�TS�f W�.��e�f�cQ��|�^���:�LXE��M�*�I(�,++ݚg���4i�^��F�L�P��8�S&�~�vV�9���L�e��]&�î: ��`�^�{��ϔ��\��� ��I\ endstream endobj 347 0 obj <>/Filter/FlateDecode/Index[8 190]/Length 29/Size 198/Type/XRef/W[1 1 1]>>stream No appointment is necessary. For reports status inquiries contact LifeLabs Customer Care Cen. Combined, they affect more than 5 million Canadians indiscriminately of age, gender or race1. 0000221225 00000 n %%EOF Requester Information. 0000005060 00000 n 0000247553 00000 n 0000248468 00000 n 0000231843 00000 n FlyClear™ by LifeLabs® offers both COVID-19 PCR / NAAT swab testing and Antibody (serology) testing to anyone needing to travel. 0000235041 00000 n 0000184159 00000 n 0000010777 00000 n ). If you are consulting via phone / virtually, you can email a PDF of the requisition form. 0000164923 00000 n 1-844-363-4357. 0000006761 00000 n THIS AREA IS FOR LAB USE Standing Order requests - expiry and frequency must be indicated Hepatitis A (anti-HAV lgM) Hepatitis B (HBsAg, anti-HBc) Hepatitis C (anti-HCV) 0000235877 00000 n 0000099774 00000 n 0000013254 00000 n 0000246481 00000 n 0000053018 00000 n Form Name: Panorama NIPT Private Pay LifeLabs req Description:National Panorama NIPT Private Pay LifeLabs requisition April 2018 Key words:Panorama, NIPT, LifeLabs . 42040 OR 42944 . GYNECOLOGIC CYTOLOGY (PAP TEST) HPV TESTING NON-GYNECOLOGIC CYTOLOGY OHIP/Insured Third Party/Uninsured WSIB Specimen Collection Date: # of Specimens Submitted # of Slides Submitted 0000072978 00000 n 0000072303 00000 n 0000236731 00000 n 0000246902 00000 n 0000025237 00000 n Tests may be purchased online (VISA or MasterCard only), at a LifeLabs Patient Service Centre (by cash, debit, cheque, VISA, or MasterCard), or using a payment form submitted with the … 0000248893 00000 n 0000248274 00000 n 0000025355 00000 n All sections on this form must be accurate and complete. trailer <<15008CF3C01A4447AA81743E4325900B>]/Prev 256252/XRefStm 3723>> startxref 0 %%EOF 348 0 obj <>stream HPV testing under the age of 30 is not recommended. 0000230610 00000 n stool sample. 0000005197 00000 n 0000247747 00000 n 0000230215 00000 n 0000246372 00000 n LifeLabs will continue to process all FIT requisitions received as fast as possible. 0000245377 00000 n All information entered above will then be automatically entered into MOH funding application form. 0000248157 00000 n 0000245652 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. 0000230067 00000 n For Inquires, contact LifeLabs Customer Care Centre 1-877-849-3637 Ver: 6.0 Current Date: 09-Nov-2017 Printed copies are uncontrolled Page 1 of 1 FLOW CYTOMETRY REQUISITION Ask.Genetics@LifeLabs.com Appointments can be made at . �=H�`�(���T��7� �D��90i�$Qo��� l��`�3pZ]�;�_lM`��d��1�: ,�,�,�,��^$Kg���� ���D��;�]"Y��*m�d/�LZ �)�`5� ��f�Azs@��w�u&F��`5���(I�����"� �dS* 0000245531 00000 n Available for PC, iOS and Android. 0000229794 00000 n 0000250403 00000 n 0000236782 00000 n 0000246255 00000 n Lifelabs Panorama NIPT 2019. Fill out, securely sign, print or email your ministry of health and long term care laboratory requisition form instantly with SignNow. Available for PC, iOS and Android. 0000240514 00000 n 0000122353 00000 n 0000073005 00000 n completed requisition form . 0000242585 00000 n LifeLabs partners with Thrive Health to make it easier and safer for Canadians to confidently return to work during the COVID-19 pandemic Dec 17 , 2019 LifeLabs releases open letter to … 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. 0000053763 00000 n 0000236817 00000 n H��W�n7}�W�QzY��e!, �R��������8n}Ich��3���e%�h�$DV��p8s��!g�V��>:�~����H 0000053693 00000 n 0000145663 00000 n 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. Private Pay Requisition. Requester Information. 0000100348 00000 n 0000229927 00000 n Laboratory Requisition Requisitioning Clinician / Practitioner Name Address Clinician/Practitioner Number Additional Clinical Information (e.g. first . 1. 1. Here is where you can access location information, hours and requisition forms: Dynacare locations across Ontario and Dynacare requisition form. 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) 0000236338 00000 n 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 tre: 1-877-849-3637 . 3. If you would like to send a digital requisition directly to LifeLabs yourself, please follow the steps in the link below. 0000238430 00000 n 0000122098 00000 n %PDF-1.4 %���� 0000238612 00000 n I request and authorize LifeLabs to test my sample(s) for the chromosome conditions listed above as indicated on my test requisition. 0000008821 00000 n SPECIFIC ALLERGEN IgE REQUEST intRlab collection label MSP permits a maximum of 5 allergens per patient per year, unless ordered by an allergy specialist. 0000244814 00000 n 0000053045 00000 n h�l�O(�a�?��}y7�99�SJ9̒�m9M;8,͟��V2 0000231281 00000 n 0000004062 00000 n 2. Please note: You must bring the same requisition you downloaded and had signed by your healthcare provider to LifeLabs in order for us to process your test. requisition. 0000164591 00000 n 0000072578 00000 n Private Pay Requisition. For accurate and timely cytologic diagnosis, provide all information required. I acknowledge that LifeLabs will send the results to my ordering healthcare provider and other providers involved in my care. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. 0000005377 00000 n I have read the Patient Information Form (on reverse). 0000233282 00000 n h�b```c``�`�``�z�A��؁�,��o``�d�0P ����7�������]�Q9��X�������vF ��}`�P~�4��lx�L��1.r�2H1$2�cx�������C%�a�7�W�$���f����x�}��[���B�{����@�_����� e�/�y�7�;H$�6T1�cxļlT�b��� � '�1�a�`� t�qC���&H1�:�6�g|4�H���� �/���H�^d�ȵ�u�a�̅���k]�tJ(B�k܊��-�r�ҧ�0p^�y�g��L?��]��`|@�kd ӄ�P�300��"���nҾ[��.-��z�;Sׯ�jӳ�J>+6.>�.��C_n_���i�$�d�V]=}U�F�R�K���������98��;E�c��'�����޾�!q{F�j%v�5|,��k&1'��W ��� Yw� K@T�'� �]�� 0000248994 00000 n 0000242915 00000 n Med-Health locations across Ontario and Med-Health requisition form. Ask.Genetics@LifeLabs.com Patient Name: Patient DOB (MM/DD/ YYYY): May 2018_v6 Page 2/8 The minimum amount of patient informationis collected for provision of the service requested. 198 0 obj <> endobj xref 198 151 0000000016 00000 n 0000243097 00000 n CEA REQUISITION For Inquires, contact LifeLabs Customer Care Centre 1-877-849-3637 Printed copies are uncontrolled Doc # 22640 Ver: 1.0 Current Date: 02-Mar-2015 Page 1 of 1 0000249610 00000 n h�bbbd`b``Ń3� �c� 4g� endstream endobj 199 0 obj <>/Metadata 6 0 R/PageLabels 3 0 R/Pages 5 0 R/StructTreeRoot 8 0 R/Type/Catalog/ViewerPreferences<>>> endobj 200 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>/Shading<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 201 0 obj <> endobj 202 0 obj <> endobj 203 0 obj <> endobj 204 0 obj <> endobj 205 0 obj <> endobj 206 0 obj <> endobj 207 0 obj <> endobj 208 0 obj <> endobj 209 0 obj <>stream 1. 0000238102 00000 n Laboratory Requisition Requisitioning Clinician / Practitioner Name Address Clinician/Practitioner Number Additional Clinical Information (e.g. 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. Requester Information All sections on this form must be accurate and complete. TO BE COMPLETED BY ORDERING DOCTOR AND PATIENT Patient Name … I understand that 1 blood ... LifeLabs Genetics complies with Canadian privacy rules. 0000098679 00000 n 0000230413 00000 n Pre-Test Preparation: CEA assays are funded by the Ontario Cancer Treatment and Research Foundation for those who meet the criteria listed on the OCTRF CEA requisition (Do not repeat more often than every 28 days). 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). Fill out, securely sign, print or email your ministry of health and long term care laboratory requisition form instantly with SignNow. 0000228799 00000 n Patients must have a signed test requisition form to get the test. This information is considered confidential. %PDF-1.6 %���� Ministry Or Health And Long Term Care Lab Requisition. All sections on this form must be accurate and complete. 0000245456 00000 n 0000229271 00000 n 0000247475 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 <. 0000249989 00000 n 0000097803 00000 n 0000003901 00000 n 0000238496 00000 n 0000183896 00000 n Laboratory Requisition This requisition form, when completed, constitutes a referral to LifeLabs laboratory physicians. 46809 OR 42096 . 0000052379 00000 n To provide notice of incoming sample, please fax requisition and a copy of the pathology report to Contextual Genomics (1-778-379-3567). 0000248091 00000 n This LifeLabs requisition is valid within British Columbia only Ver: Oct 2015 Laboratory Requisition – Specialty and Contract Services This requisition form, when completed, constitutes a referral to LifeLabs laboratory physicians LifeLabs Medical Laboratory Services 3680 Gilmore Way Burnaby BC V5G 4V8 Tel: 604-507-5234 Test Summary Label These forms generally contain patient demographic and registration information (e.g. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. Start a free trial now to save yourself time and … 0000145005 00000 n For results interpretation inquiries, please call: 416-675-4530 Ext. CYTOLOGY & HPV TESTING REQUISITION Inadequate clinical information may hinder diagnosis. 0000249072 00000 n endstream endobj startxref 0000232034 00000 n 0000240897 00000 n 0000230808 00000 n 0000242981 00000 n first 0000231006 00000 n 0000241284 00000 n 0000231757 00000 n Requester Type (check one): Physician. 0000164331 00000 n [���ѵt��;f/�3i��o*{��[{ Fine Needle Aspirate (FNA) or Fluid Send in sterile screw cap container. in the pre- addressed, postage-paid envelope. Fax the requisition to 1-833-676-1427. Laboratory Requisition This requisition form, when completed, constitutes a referral to LifeLabs laboratory physicians. According to Public Health Ontario, serology testing should not be used for the … Ensure all other fields of the funding form are completed (clinical diagnosis, etc. 0000004789 00000 n 0 ���$3�3����ѧ������NO����iNs6:mG� �8i[|�~ A3BT�����a���|�9NViv�F�h�IQ����}�v?2�� endobj 0000231921 00000 n This informationis considered confidential. 0000244235 00000 n 0000184481 00000 n 0000004921 00000 n 0000229467 00000 n Fax the requisition to 1-833-676-1427 2. information please call LifeLabs, Customer Care Centre at 1-877-849-3637. Ask.Genetics@LifeLabs.com May 2018_v6 Page 1/8 The minimum amount of patient information is collected for provision of the service requested. We have launched a centralized service to accept fax and email electronic requisitions for patients and we have seen an overwhelming increase in utilization of this service. o. OHIP Requisition Essential Information QRA Oct 2013 MOHTLC Requisition Essential Information To be completed fully and clearly by Client and Phlebotomist LifeLabs, hospital outpatient labs). CYTOLOGY & HPV TESTING REQUISITION Inadequate clinical information may hinder diagnosis. Complete this requisition (1 page), all fields are mandatory. Contact phone: 1-84-GENEHELP (1-844-363-4357). 0000245299 00000 n 0000241334 00000 n Call LifeLabs for questions: 1-833-676-1426. 0000246189 00000 n 0000236895 00000 n 0000016148 00000 n 7) What happens if my result comes back positive? Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. 0000246586 00000 n 0000020715 00000 n 0000025570 00000 n 0000228904 00000 n 0000246707 00000 n 0000098072 00000 n 0000228760 00000 n 1-844-363-4357. 0000025425 00000 n 0000245276 00000 n I��8��;�� ��A$�B�C���x0yL�`��=��"���2E��\��.���°̆��8������C�E Ask.Genetics@LifeLabs.com Appointments can be made at . 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. These forms generally contain patient demographic and registration information (e.g. In the event of a high risk or no result, I acknowledge that LifeLabs may contact 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. Kent Dooley, PhD Clinical Chemist, LifeLabs BC Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are conditions that present with chronic abdominal pain and disrupted bowel habits. I understand that 1 blood ... LifeLabs Genetics complies with Canadian privacy rules. 0000025121 00000 n If you have recently sent a FIT requisition for your patient, please do not send a repeat order unless at least 4 to 6 weeks have passed and your patient has not already received a FIT kit, as there remains the potential for mailing delays resulting from COVID-19. 0000231808 00000 n 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 … Fax the requisition to 1-833-676-1427. LifeLabs Genetics strives to make the ordering process as straight forward as possible. 0000100052 00000 n Ministry Or Health And Long Term Care Lab Requisition. If you have a proposal or document you’d like to include as additional information, please upload here. 0000248971 00000 n Non-CCC Program (Red Card) • Bring the c ompleted test kit and requisition form back to a LifeLabs location within 10 days of collecting your . information please call LifeLabs, Customer Care Centre at 1-877-849-3637. It is for the use of authorized health care providers only. 0000006542 00000 n I have read the Patient Information Form (on reverse). 0000247374 00000 n .+�,|�r��BpQ��*3�KS�������. It is for the use of authorized health care providers only. 0000053887 00000 n You must bring your signed requisition form to your chosen LifeLabs location. 0000241369 00000 n The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. For technical inquires contact Flow Cytometry at: 416-675-4530 Ext. 0000099292 00000 n Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. 0000233677 00000 n CEA REQUISITION For Inquires, contact LifeLabs Customer Care Centre 1-877-849-3637 Printed copies are uncontrolled Doc # 22640 Ver: 1.0 Current Date: 02-Mar-2015 Page 1 of 1 Private Pay Laboratory Requisition - Panorama NIPT This requisition form, when completed, constitutes a referral to LifeLabs/BC Biomedical Laboratories physicians. LifeLabs will only report test … 0000239819 00000 n Please note that this information will only be referenced for additional details and not necessarily considered as a part of your application. 0000245198 00000 n

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