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Mandatory Blood Testing Act Lab Requisition (ON00502E)

Ontario uses form ON00502E, under the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07, to requisition STAT tests on a respondent's blood sample after someone came into contact with their bodily substance. The physician or nurse practitioner orders HIV, hepatitis B surface antigen and anti-HCV testing, or the tests are ordered on the authority of the Consent and Capacity Board. The sample and form go to a Public Health Ontario laboratory.

Who completes it

The physician or nurse practitioner ordering the tests completes Section B with their CPSO or CNO number, or records the Consent and Capacity Board order date and file number. The respondent completes Section A, and the person who collects the blood completes the Section C checklist.

Submitting and payment

How to submit it
The completed requisition is couriered with the sample to a Public Health Ontario laboratory under Transportation of Dangerous Goods rules; the collector keeps a copy and gives one to the respondent.

Good to know

  • Section C's checklist covers identification, labelled vacutainers, tamper-proof biohazard packaging, TDG shipping, copies for records and the respondent, and notifying the Medical Officer of Health.
  • If any checklist item is answered no, testing may be cancelled, so the collector explains any exception in the space provided.
  • Section A names the Medical Officer of Health where the respondent lives, the date of exposure and, optionally, the respondent's own physician or nurse practitioner.
  • A static print version is also posted in the Central Forms Repository; the fillable version is an XFA form that needs Adobe Acrobat or Reader.

Get the official form

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

Laboratory Requisition (Mandatory Blood Testing Act)

Demande d’analyse en laboratoire

Official pagePDFVersion française

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Frequently asked questions

Which tests does the MBTA laboratory requisition order?

Section B lists three STAT tests: HIV, hepatitis B surface antigen (HBs Ag) and anti-HCV. The ordering physician or nurse practitioner marks the tests requested, or the requisition notes that testing was ordered on the authority of the Consent and Capacity Board, with the order date and file number.

Where is the MBTA blood sample sent?

The form tells the collector to courier the completed requisition and the sample to a Public Health Ontario laboratory and lists eleven sites across Ontario. Samples are shipped under the Transportation of Dangerous Goods Act, and the laboratory records whether they were acceptable and tested.

Is the MBTA requisition available in French?

Yes. The French version, Demande d'analyse en laboratoire, is posted with the English ON00502E (2024/11) in Ontario's Central Forms Repository, along with a static, non-fillable version of the form for printing.