The accuracy, completeness and legibility of all relevant information on laboratory requisition forms at the time submission of the specimens to the laboratory will ensure:

    • Positive identification of patient and ordering clinician
    • Specimen integrity is maintained
    • Correct tests are performed
    • Timely testing and reporting of all laboratory test results
    • Prompt communication of critical results to the ordering clinician, or designate
    • Patient care is not compromised
    • Delays in treatment are prevented
    • Timely testing and reporting of all laboratory test results
    • Patients are not inconvenienced due to having to be recalled

Please Provide The Following Information On Laboratory Requisitions:


Patient information

    • Health Card number (10 digits) and Version Code
    • Gender
    • Date of birth (YYYY-MM-DD)
    • Telephone Number
    • Last name (as per Health Card)
    • First and Middle names (as per Health Card)
    • Address (including postal code)

Clinician/Practitioner information

  • Full name
  • Address
  • Clinician/Practitioner number
  • CPSO/ Registration number
  • “Copy to” Clinician/Practitioner information
    In order to protect patient privacy, all requests for “copy to” reports should include the information noted below. If this information is not provided on the laboratory requisition, the laboratory will send an extra copy of the report to the ordering clinician’s office for distribution to the “copy to” clinician.
  • “Copy To” Clinician’s full name
  • Address and Telephone number
  • Clinician/Practitioner number

Additional clinical information

  • Additional clinical information about a patient that is relevant to the ordered tests will be helpful to the laboratory. Such information can be included on the requisition under the “Additional Clinical Information”

Dedicated Requisitions

    • Dedicated requisitions are required for Cytology, Anatomical Pathology, Colon Cancer Check FOBT (CCC-FOBT) and for testing performed by Ontario Agency for Health Protection and Promotion (OAHPP) See Downloadable Forms


Test Ordering Process


Specimens must be accompanied by a fully completed Laboratory Requisition signed and dated by the ordering clinician.


    • MOHLTC laboratory requisition:
      All specimens sent to the laboratory or Patient Service Centres must be accompanied by a fully completed Ontario Ministry of Health and Long Term Care (MOHLTC) laboratory requisition form signed and dated by the ordering clinician. Electronic signatures are not currently acceptable to MOHLTC.See Downloadable Forms

 

    • Cytology requisition:
      Specimens for Cytological examination require a dedicated, fully completed Cytology requisition, signed and dated by the ordering clinician. Please include all required clinical information.See Downloadable Forms

 

    • Anatomical Pathology requisition:
      Specimens for anatomical pathology require a dedicated, fully completed Anatomical pathology requisition signed and dated by the ordering clinician.  Please include all required clinical information. See Downloadable Forms

 

    • Ontario Agency for Health Protection and Promotion requisition:
      Specimens for testing performed by OAHPP must be accompanied by a dedicated, fully completed OAHPP requisition signed and dated by the ordering clinician. See Downloadable Forms

 

    • Specialized Testing requisitions:
      Specimens for specialized tests such as CEA, MSS, etc., must be accompanied by a fully completed dedicated form in addition to the regular requisition. Please contact our Client Services Department at (416) 449-2166 for further information.

 

    • Colon Cancer Check – Fecal Occult Blood Test (CCC-FOBT):
      ColonCancerCheck fecal occult blood kits must be accompanied by a fully completed Ontario Ministry of Health and Long Term Care (MOHLTC) laboratory requisition form, signed and dated by the ordering clinician.  If other tests are required for the same patient, a separate MOHLTC requisition must be completed. See Downloadable Forms

Patient identification on requisition and specimens must match exactly to avoid rejection of specimens.

Each specimen must be labeled with two unique patient identifiers (First and Last name and date of birth or Health Card Number) and date of collection. Please see Guidelines for Specimen Identification and Acceptance for time sensitive tests (e.g. therapeutic drugs), and tests that have serial blood draws (e.g. GTT) both the date and time of sample collection MUST be clearly indicated on the specimen(s) in addition to the two unique patient identifiers.

Specimens that do not meet criteria specimen identification, or other acceptance criteria, will not be processed. Please see Guidelines for Specimen Identification and Acceptance. Laboratory tests must be individually and clearly marked on the requisition. Ordering of tests by profile or panel is not acceptable under MOHLTC policy.

To avoid misinterpretation which may compromise specimen integrity, or lead to delays in testing, please use the same test name/terminology listed in our Laboratory Test Requirements. For any test not listed in our Laboratory Test Requirement Manual, please contact our Client Services Department at (416) 449-2166 for further information. For tests performed by the Ontario Public Health laboratory (OPHL), please refer to OPHL’s Specimen Collection Guide.

Uninsured Tests

The patient is responsible for payment of tests not covered under Ontario Health Insurance Plan (uninsured tests). Patients should be made aware of the cost of the uninsured test(s) prior to collection of specimens. Please call our Client Services Department at (416) 449-2166 to confirm pricing for uninsured tests.


Repeat Tests

For patients requiring repeat testing, the initial requisition signed by the clinician is only valid for the period specified by the ordering clinician. In accordance with MOHLTC policy, repeat testing on individual patients can be ordered for a maximum of six months without a new requisition. A copy of the initial requisition will be retained at the Patient Service Centre where the original service was provided, for the period specified on the requisition.


“To follow” Tests

“To follow” specimens (e.g. stool, sputum, 24 hour urine collection etc.) that require the patient to collect the samples at home, are accepted up to thirty days from the date of service on the original laboratory requisition. “To follow” specimens submitted to the laboratory beyond the thirty days require a new requisition signed by the ordering clinician.


Verbal requests

Verbal requests for test(s) are discouraged; however, under special circumstances an exception may be made. A completed requisition signed by the ordering clinician should be forwarded to the laboratory as soon as possible.


“Add-on” tests

Clinicians may order additional tests (“Add-on” tests) on stored samples when clinically indicated. Acceptance of requests for “Add on” test(s) is based on: sample availability, sample quantity, and sample integrity (e.g. age and suitability). The laboratory will forward the required documentation to the ordering clinician for signature.


Patient access to test results

Patient access to test results is possible only when the ordering clinician has indicated on the requisition that access is permitted. Patient access applies only to the requisition in question.



Dedicated Requisitions

    • ColonCancerCheck-FOBT (CCC-FOBT) no other test can be ordered on the same MOHLTC laboratory requisition
    • Cytology
    • Anatomical  pathology
    • Ontario Public Health Laboratories (OPHL)


Guidelines for Specimen Identification


Ontario Laboratory Accreditation (OLA) program has developed stringent criteria and standards for Specimen Identification and Acceptance in accordance with good clinical practice. Each specimen must be labeled at the time and point of collection with the patient’s full name (or unique code number in the case of anonymous testing), one other unique identifier (e.g. date of birth, Health Card number, accession number or patient chart number). Specimen labels shall also include the date of collection, and for time sensitive tests, the time of collection. Strict adherence to proper pre-analytical procedures in clinician’s offices, Patient Service Centres and laboratories, is essential for:

Patient safety

Maintaining
analytical quality

Minimizing error


Deficiencies due to improper or incomplete identification of specimens and/or requisitions may result in delayed or incomplete testing, or in most cases rejection of the specimen(s). This policy is fundamental to patient safety. Specimens that fail to meet acceptance criteria will be rejected. Such specimens will not be processed and will not be returned to the referring clinician’s office.

Exceptions will be made for specimens considered to be ‘irretrievable’ or ‘difficult to collect’. Please see Irretrievable/Difficult to Collect Specimens.

Specimen Acceptance Criteria


Specimens must be properly labelled for patient safety and to prevent delays in testing resulting from specimen rejection. Please see Guidelines for Specimen Identification

Please note the following additional points to ensure specimens meet acceptance criteria:

  • Label all specimens with two unique patient identifiers and the date of specimen collection.
  • Verify that identification on specimens and requisition match.
  • Provide a fully completed requisition signed by the referring clinician.
  • Use correct vacutainer tube/container for specimen collection.
  • Follow specimen handling and transportation requirements (e.g. ship frozen, protect from light etc.)
  • Collect sufficient quantity of specimen for tests ordered.
  • Ensure correct ratio of blood to anticoagulant (e.g. INR testing).
  • Use containers with correct preservative.
  • Check expiry dates on vacutainers and specimen collection kits prior to specimen collection.


Irretrievable and Difficult to collect samples

 

Special consideration will be given to irretrievable and difficult to collect specimens for which outright rejection may lead to a potential risk to the patient. The following list is not exhaustive but includes those specimens for which both clinician and the laboratory must pay special attention:

  • Histopathology and cytology specimens (other than gynaecological smears, urines and sputa)
  • Tissue aspirates for microbiology or cytology
  • Biopsy material
  • Blood cultures in height of fever
  • Cerebrospinal fluid (CSF)
  • Synovial fluid
  • Kidney stones
  • IUD’s or other foreign objects for culture
  • Specimens collected from infants

If the ordering clinician can be identified, the laboratory will provide notification that an unlabelled, irretrievable specimen has been received. Such specimens may be returned to the ordering clinician’s office to initiate further investigation and to seek possible resolution.

Under certain circumstances, when specimen integrity may be compromised due to a delay in processing, the laboratory may proceed with the testing. For such specimens reports will only be generated and released upon the request of the ordering clinician. A disclaimer will be included on the report clearly stating that the unlabelled specimen received by the laboratory was identified by the clinician and the test results should be interpreted with caution.


Coded Specimens

Coded specimens received with a unique alpha, numeric, or alpha/numeric identifier assigned by the clinician, together with a second unique identifier are acceptable for HIV testing.




Order of Draw for Blood Collection


Alpha Laboratories will supply colour coded sterile evacuated plastic tubes for blood collection to referring clinicians who perform phlebotomy in their office. To order vacutainer supplies please see Laboratory Supplies.

To determine the correct tube for each test, please refer to the alphabetical test listing in the Laboratory Test Requirements.

To confirm the order of vacutainer draw for blood collection please see Specimen Requirement Chart – Order of Draw Chart

All specimen containers must be clearly labeled with two unique patient identifiers: patient’s full name and one other identifier, (such as Date of Birth, Health Card Number or patient chart number), and date of collection.

Please also provide time of collection for time sensitive tests, and specimens requiring serial sampling (e.g. GTT).


Please note the following when using vacutainer tubes:

  • Select the appropriate type, and number of tubes for the required tests.
  • Check expiry date of tubes.
  • Use safety engineered needles for blood collection.
  • If blood culture is required it should be the first collection in the order of blood draw.
  • Collect blood into tubes in the correct order of draw to avoid erroneous or misleading test results.
  • Allow blood tubes to fill completely to avoid erroneous results.
  • Correctly position the patient’s arm and collection tube.
  • Avoid excessive thumb pressure on end of tube.
  • Avoid thumb or finger pressure around venipuncture site during the phlebotomy.
  • Prolonged tourniquet application may cause:  i) false test values due to increases in serum constituents and ii) hemolysis of the specimen, which may interfere with some test procedures, result in increases in test values.
  • For tests containing an anticoagulant gently invert the tube several times immediately after blood collection.
  • Label specimens at the time and point of collection.

orderofdraw_chart