What the 21996 is for
The 21996 orders QuantiFERON testing for latent TB infection in patients who meet one of the indications on the form. The result helps decide on latent TB treatment before immune suppression or transplant, and for immigration or TB program screening. A negative result doesn’t rule out latent infection in a patient with very high exposure risk or immune suppression, and the test has no role in diagnosing active disease.
Who completes it
The ordering clinician completes the patient and provider details, chooses the indication, checks the contraindications, and prints their name and signs as approving clinician. The patient doesn’t complete any part.
How to fill in the requisition
Patient and provider details
Enter PHN, legal name, date of birth, phone and address, and the authorizing provider with Connect Care IDs where you have them. Add copy-to providers who need the result.
Appropriate indications
Check one: current or anticipated immune suppression, HIV, chronic kidney disease, current or anticipated bone marrow or solid organ transplant, hematologic malignancy, a refugee from a TB-endemic country, TB program testing, a requirement of Immigration, Refugees and Citizenship Canada, or other with a stated reason. Only one box is needed. An “other” with no reason is the usual cause of a query from the lab.
Contraindications
The test shouldn’t be done if the patient has had a previous positive QFT, a previously positive TST unless you have consulted the TB program, any treatment for active or latent TB, or suspected active TB. Check the chart and ask the patient before you order, because a prior skin test done elsewhere is easy to miss.
Approving clinician
Print your name, sign and date the requisition.
Common reasons the test isn’t done
- No indication checked, or “other” with no reason.
- A contraindication present, often a prior positive skin test.
- Ordered to investigate symptoms of active TB.
- Unsigned requisition.
Submitting and who pays
The patient takes the requisition to an APL collection site. The report goes to you and any copy-to providers, and a separate consultation request is needed if you want TB services involved. Ordering is part of the visit, so there is no form fee. APL released a new Test Directory in July 2026 for providers without Connect Care. Check it for current collection requirements, which depend on the location you select.