0000249793 00000 n 0000242981 00000 n 0000246372 00000 n 0000072978 00000 n 0000230610 00000 n 0000145254 00000 n 0000246586 00000 n Call LifeLabs for questions: 1-833-676-1426 1. 0000231281 00000 n For reports status inquiries contact LifeLabs Customer Care Cen. 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) 0000003901 00000 n stool sample. SPECIFIC ALLERGEN IgE REQUEST intRlab collection label MSP permits a maximum of 5 allergens per patient per year, unless ordered by an allergy specialist. 0000229927 00000 n �=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* 46809 OR 42096 . 0000164923 00000 n o. 0000122777 00000 n 0000249676 00000 n Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. 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. Check box if patient requires a new FIT kit (i.e., FIT was lost, damaged, or not received) and complete this form. Here is where you can access location information, hours and requisition forms: Dynacare locations across Ontario and Dynacare requisition form. 0000010777 00000 n 0000240897 00000 n For accurate and timely cytologic diagnosis, provide all information required. [���ѵt��;f/�3i��o*{��[{ 0000233677 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. 0000245652 00000 n Available for PC, iOS and Android. 0000238496 00000 n 0000053887 00000 n trailer <<15008CF3C01A4447AA81743E4325900B>]/Prev 256252/XRefStm 3723>> startxref 0 %%EOF 348 0 obj <>stream 0000233793 00000 n LifeLabs Genetics strives to make the ordering process as straight forward as possible. 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. 0000229665 00000 n CYTOLOGY & HPV TESTING REQUISITION Inadequate clinical information may hinder diagnosis. 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) 0000231921 00000 n Provide requisition to patient, and have them visit their local LifeLabs patient service centre for collection and payment (if applicable). 0000025121 00000 n Fax the requisition to 1-833-676-1427. Requester Information All sections on this form must be accurate and complete. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. 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. completed requisition form . Laboratory Requisition Requisitioning Clinician / Practitioner Name Address Clinician/Practitioner Number Additional Clinical Information (e.g. 0000100348 00000 n 0000233282 00000 n Blood can be collected at any blood collection facility (e.g. This information is considered confidential. As COVID-19 continues on, many airlines or countries now ask for proof of COVID-19 clearance within a specific timeframe or window. 0 Fill out, securely sign, print or email your ministry of health and long term care laboratory requisition form instantly with SignNow. 0000246481 00000 n Requester Information. 0000236895 00000 n 0000005377 00000 n 0000145663 00000 n All sections on this form must be accurate and complete. This informationis considered confidential. 0000005767 00000 n 0000099774 00000 n FlyClear™ by LifeLabs® offers both COVID-19 PCR / NAAT swab testing and Antibody (serology) testing to anyone needing to travel. 0000247374 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). 0000230808 00000 n 0000242915 00000 n 0000006761 00000 n Ask.Genetics@LifeLabs.com Appointments can be made at . Requester Type (check one): Physician. If you would like to send a digital requisition directly to LifeLabs yourself, please follow the steps in the link below. 0000246902 00000 n 0000245276 00000 n 0000228760 00000 n 0000073471 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 0000246255 00000 n 0000231006 00000 n 0000164591 00000 n 0000240975 00000 n 0000236260 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). in the pre- addressed, postage-paid envelope. Call LifeLabs for questions: 1-833-676-1426. These forms generally contain patient demographic and registration information (e.g. 42040 OR 42944 . Fine Needle Aspirate (FNA) or Fluid Send in sterile screw cap container. • Mail it or drop it off at the nearest LifeLabs location within 10 days of collecting your . 0000246707 00000 n Private Pay Requisition. LifeLabs will only report test results to the ordering healthcare provider(s) or Start a free trial now to save yourself time and … 0000241369 00000 n first . GYNECOLOGIC CYTOLOGY (PAP TEST) HPV TESTING NON-GYNECOLOGIC CYTOLOGY OHIP/Insured Third Party/Uninsured WSIB Specimen Collection Date: # of Specimens Submitted # of Slides … 0000184159 00000 n The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Contact phone: 1-84-GENEHELP (1-844-363-4357). Ministry Or Health And Long Term Care Lab Requisition. Complete this requisition (1 page), all fields are mandatory. These forms generally contain patient demographic and registration information (e.g. 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 <. 1-844-363-4357. No appointment is necessary. 0000098679 00000 n 0000122098 00000 n I have read the Patient Information Form (on reverse). 0000004789 00000 n ���$3�3����ѧ������NO����iNs6:mG� �8i[|�~ A3BT�����a���|�9NViv�F�h�IQ����}�v?2�� endobj xref 198 151 0000000016 00000 n 0000245456 00000 n 0000003723 00000 n 0000004921 00000 n 0000236782 00000 n 0000231808 00000 n 0000249268 00000 n h�l�O(�a�?��}y7�99�SJ9̒�m9M;8,͟��V2 0000235877 00000 n 0000241334 00000 n requisition. h�bbd```b``���G@$s��L�C����!�j��"T��Ig0y ). If you have a proposal or document you’d like to include as additional information, please upload here. 1-844-363-4357. H��W�n7}�W�QzY��e!, �R��������8n}Ich��3���e%�h�$DV��p8s��!g�V��>:�~����H 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 … 0000053693 00000 n 0000235041 00000 n 0000239819 00000 n 0000221186 00000 n 1. 0000231843 00000 n 0000248157 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 . tre: 1-877-849-3637 . In the event of a high risk or no result, I acknowledge that LifeLabs may contact 0000231757 00000 n 0000025570 00000 n 0000247475 00000 n 501 0 obj <> endobj 0000236731 00000 n 0000238102 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). 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