The prenatal counterpart to BC's standard outpatient lab requisition, laid out by gestational age around the tests Perinatal Services BC recommends: 0 to 14 weeks, 24 to 28 weeks, 36 to 37 weeks, plus risk-based tests. Maternity care providers use it from the first prenatal visit and record the estimated date of confinement. The patient takes it to a laboratory, and the 2026/05/15 edition is current.
The practitioner providing maternity care completes the billing, practitioner, copy-to, patient, EDC, diagnosis, medication and test sections and signs it. The collector completes the collection date, time and collector boxes.
Download the current version from the source each time; forms change without notice.
Standard Out-Patient Laboratory Requisition for Maternity Care
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
At 36 to 37 weeks the form lists a hematology profile (CBC) and the Group B Strep screen by vagino-anorectal swab, with a penicillin allergy box. Syphilis screening is added after 35 weeks for patients planning a home birth. Risk-based tests at 28 to 32 weeks include repeat HIV serology, chlamydia and gonorrhea NAAT, and syphilis screening.
Yes. Under Other Tests as Clinically Indicated, thyroid function offers TSH only for monitoring replacement therapy, or TSH-first algorithms for suspected hypothyroidism or hyperthyroidism, marked for physician referrals only. The 0 to 14 week risk-based list also includes TSH for patients with risk factors for hypothyroidism, alongside hepatitis C and fasting glucose or A1c.
PHSA's Standard Outpatient Laboratory Requisitions page links the gov.bc.ca file for HLTH 1935, alongside HLTH 1901 and the pharmacist version. Laboratory operators may also publish branded copies, which must keep the provincial content and layout. Check that the footer reads HLTH 1935 2026/05/15 before printing it or loading it into an EMR.