The 13 requisitions and referral forms used across a whole province, from Ontario's lab requisition to BC's standard outpatient requisition, with what each covers and which edition is current.
Several provinces publish one standard requisition for community lab tests. Ontario's Laboratory Requisition (4422-84) is the best known. BC uses the Standard Out-Patient Laboratory Requisition (HLTH 1901), with a maternity version (HLTH 1935) for prenatal testing. Alberta Precision Laboratories uses the General Laboratory Requisition (21302), Newfoundland and Labrador the Outpatient Specimen Collection Requisition (R0001), and PEI Health PEI's Laboratory Blood Test Request Form. Manitoba's Shared Health has one biochemistry and hematology requisition for Winnipeg and Brandon (R250-10-94) and another for clinics outside them (R250-10-92).
Imaging is less standardized. Manitoba has required its provincial CT Request Form (R250-10-115) for all urgent and elective CT exams since January 30, 2026, and uses a standard MRI Request Form (R130-80-04). BC has a standard bone densitometry requisition (HLTH 1905), and Alberta Health Services takes consultation requests on the Connect Care Referral (21396). Editions change: BC's 2026/05/15 requisitions replace older copies, which must be swapped out by November 15, 2026. Provinces without one standard form, such as Saskatchewan, Québec and Nova Scotia, use regional or hospital requisitions.
BC's Minister-approved standard requisition for ordering common outpatient laboratory tests and directing payment to MSP, ICBC, WorkSafeBC, the patient or another payer.
BC's standard requisition for bone mineral densitometry, recording fracture-risk category and whether the exam is MSP-insured diagnostic BMD, an allowed early follow-up, or patient-pay non-diagnostic BMD.
BC's standard requisition for prenatal laboratory testing, organized by gestational age around Perinatal Services BC recommendations, plus other tests as clinically indicated.
APL's provincial community requisition for routine blood work and common chemistry, hematology, serology, urine, drug-level, cardiovascular risk and screening tests.
General AHS referral form for sending a consultation or e-Consult request, with clinical background and attachments, to an AHS service that uses Connect Care.
R130-80-04Manitoba's standard requisition for MRI examinations, including MRI safety pre-screening, IV contrast renal questions and pediatric sedation prompts.
Shared Health's standardized requisition for outpatient biochemistry, hematology, drug levels and basic urine and point tests ordered from clinics and community settings outside Winnipeg and Brandon.
Shared Health's standardized requisition for outpatient biochemistry, hematology and therapeutic drug monitoring ordered from clinics and community settings in Winnipeg and Brandon.
R250-10-115Standardized provincial requisition required for all urgent and elective CT examinations performed in Manitoba, used for outpatient, emergency and inpatient requests.
Standard Ontario requisition for community laboratory tests ordered by a physician or other authorized practitioner.
101038.0007Health PEI's provincial requisition for blood tests at the Provincial Clinical Laboratory and hospital collection sites, covering chemistry, cardiac and lipid, tolerance, nutritional, endocrine and tumour marker, blood gas and drug-level testing.
Health PEI's provincial requisition for diagnostic imaging: general radiography, CT, nuclear medicine, BMD, mammography, ultrasound and MRI.
Newfoundland and Labrador's provincial requisition for most routine outpatient laboratory tests, including hematology, chemistry, drug levels, urine, prenatal and common infection tests.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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HLTH 1901 dated 2026/05/15. It replaces the 2026/01/01 edition and removes the non-nominal HIV reporting option, because BC now requires all HIV reporting to be nominal. Clinicians and labs must replace outdated copies, including laboratory-branded versions, by November 15, 2026. Branded versions may change only the header. Prenatal testing uses the maternity version, HLTH 1935.
The patient's full legal name and at least one unique identifier, such as the ULI or PHN, since date of birth does not count. Reports route on both the Connect Care Provider ID and the Submitter ID, so enter both. Tick CBC and Differential when the white cell differential matters, because a differential is not automatic with a CBC. The current revision is 21302 (Rev2026-09).
Yes. Since January 30, 2026, Shared Health requires the CT Request Form (R250-10-115) for all urgent and elective CT exams, for outpatient, emergency and inpatient requests. Clinical and surgical history must not be left blank, the patient's weight is always required, and incomplete asterisked fields send the form back. Outpatient requests for Winnipeg sites go through Diagnostic Imaging Central Intake.