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Mandatory Blood Testing Act Form 1 (ON00460E)

Under Ontario's Mandatory Blood Testing Act, 2006, a person who came into contact with another person's bodily substance, such as a first responder or a victim, can apply to have that respondent's blood tested. Form 1 is the reporting physician's or nurse practitioner's report supporting the application, covering the exposure, examination, immunization history, baseline testing, prophylaxis, counselling and a risk assessment.

Who completes it

The reporting physician or nurse practitioner completes all sections, A to I, and signs the assessment. The applicant's primary care provider and any separate counselling practitioner are identified on the form.

Submitting and payment

How to submit it
The completed report is given to the applicant, who submits it with their application to the Medical Officer of Health where the respondent lives; a qualifying application is referred to the Consent and Capacity Board.

Good to know

  • The applicant must consent to counselling, including counselling on prophylaxis or treatment; otherwise the application does not proceed.
  • Baseline testing for anti-HBc, HBsAg, anti-HBs, anti-HCV and HIV antibody is mandatory unless the practitioner has satisfactory evidence of seropositivity, and the requisition is marked STAT.
  • Section I rates the applicant's exposure risk for HIV, hepatitis B and hepatitis C as potentially significant, non-significant or indeterminate, with reference to current protocols.
  • Baseline results should be copied to the applicant's family physician or nurse practitioner, if known, and to the reporting practitioner named in Section B.

Get the official form

Download the current version from the source each time; forms change without notice.

Form 1 - Physician/Nurse Practitioner Report (Mandatory Blood Testing Act, 2006)

Rapport du médecin/de l’infirmière ou l’infirmier praticien

Official pagePDFVersion française

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Frequently asked questions

What happens after the MBTA Form 1 is completed?

The practitioner gives the report to the applicant. If the applicant submits an application that meets the regulations to the Medical Officer of Health where the respondent lives, the application, including this report, is referred to the Consent and Capacity Board.

What exposures does MBTA Form 1 record?

Section C records the date, time and type of exposure: a percutaneous injury such as a needle stick, a bite that breaks the skin, or contact with non-intact skin, mucous membranes, the vagina or anus. It also records the bodily substance involved and the applicant's account of what happened.

Which related forms are used under the Mandatory Blood Testing Act?

Form 2 is the Applicant Report (ON00461) and Form 3 the Respondent Report (ON00462). A separate Laboratory Requisition (ON00502E) goes with the respondent's sample to Public Health Ontario. Form 1 itself is posted in English and French, with a static print version.