Newfoundland and Labrador's provincial requisition for most routine outpatient laboratory tests, listed on the Provincial Laboratory Formulary. It covers CBC and INR, type and screen, chemistry, lipids, TSH, PSA, drug levels, urine tests, a prenatal screen and common infection tests, each with its laboratory mnemonic. The current printed edition is R0001MAY24; microbiology, cytology, pathology and other specialized testing use separate requisitions.
The ordering provider completes patient identification, provider details with signature, Meditech and EMR mnemonics, copy-to provider, diagnosis and tests. The specimen collector records the collection date and time, signature and notes.
Download the current version from the source each time; forms change without notice.
Outpatient Specimen Collection Requisition
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The Eastern zone laboratory requisitions policy accepts approved requisitions up to twelve months from the date of issue. A requisition missing information, for example without a health care number or second identifier, must be replaced by a new one from the provider before collection or testing can start.
For non-residents, an out-of-province requisition is accepted if fully completed with the requester's name, mailing address and signature, the patient's name, date of birth, health care number and expiry, a phone number for critical results, and a fax number if needed. For NL residents, it also needs a Laboratory Test Special Authorization form.
The Prenatal Screen (PNS) box includes CBC, HIV, rubella, hepatitis B surface antigen and syphilis screening, and type and screen is a separate box in the same section. Glucose tolerance options include a 50 g non-fasting screen and a 75 g OGTT for prenatal use after an 8-hour fast.