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HLTH 1905

Standard Out-Patient Bone Densitometry Requisition

HLTH 1905 is how a primary care provider orders a bone density scan in BC. MSP covers diagnostic BMD only for patients at moderate or higher fracture risk when the result is likely to change treatment, so the risk category and history you record decide whether the exam is insured.

At a glance

Checked October 2026

Form number
HLTH 1905
Issued by
BC Ministry of Health
Where
British Columbia
Completed by
Requesting practitioner (family physician or nurse practitioner)
Format
Fillable PDF
Language
English

What the HLTH 1905 is for

HLTH 1905 orders a bone mineral densitometry scan at an outpatient facility in BC. The form separates three kinds of exam: diagnostic BMD for patients at moderate or high fracture risk, follow-up BMD measurements, and non-diagnostic BMD that the patient pays for. Which section you complete decides whether MSP pays.

Who completes it

The requesting practitioner completes and signs the whole form. BC Women’s Hospital, one of the main referral sites, asks for every section to be filled in and triages each request before booking.

How to fill in the requisition

Patient details and pertinent history

Complete the yellow fields, the Bill to choice, diagnosis and current medications. Record whether the patient has had a previous bone densitometry or lumbar spine X-ray, with location and date. Follow-up scans should be done at the same location, so the prior site matters.

Diagnostic bone mineral densitometry

Check one risk category: moderate risk (10 to 20% ten-year fracture risk), high risk (over 20%), recent hip fracture, hyperparathyroidism or a history of fragility fracture. The form points to the FRAX calculator for the risk estimate. Risk factors it lists include age over 65, current smoking, more than three units of alcohol a day, a parent with a hip fracture, rheumatoid arthritis, secondary osteoporosis, and glucocorticoids at 7.5 mg prednisone or more daily for three months.

Follow-up BMD measurements

Tick whether three or more years have passed since the prior exam. Under three years, choose one of the exceptions: glucocorticoid therapy needing a baseline and scans every six months, moderate or high-risk patients on treatment with multiple risk factors, primary hyperparathyroidism, or another high-risk situation you specify. The trap is ordering an early repeat with no exception ticked.

Non-diagnostic BMD, patient pay

Use this section for screening the patient wants to pay for, or follow-up that isn’t clinically indicated. Routine screening under 65, screening around menopause, chronic back pain and exaggerated dorsal kyphosis are examples the form gives of uninsured indications.

Patient history and signature

Summarize risk factors and current or past osteoporosis therapy in the patient history box, then sign and date. Attach previous reports if you have them.

Common reasons it’s declined or delayed

  • No risk category ticked, or a risk estimate that doesn’t support an insured exam.
  • An early repeat scan with no exception selected.
  • Screening indications ordered as diagnostic BMD.
  • Previous BMD location and date left blank.
  • An incomplete form, which BC Women’s will decline and return to you.

Submitting and who pays

Fax the completed requisition to the facility. BC Women’s takes it at 604-875-2367 and contacts the patient directly to book. MSP pays for diagnostic BMD that meets the guideline. Non-diagnostic exams are billed to the patient.

Get the official form

Download the current version from BC Ministry of Health each time. Forms change without notice, and an old edition can be returned.

Official page ↗ PDF ↗

Medulla Forms

Fill HLTH 1905 from the visit and the chart.

Upload the fillable PDF to your practice's forms once. Medulla fills it from the visit and the chart open in your EMR, leaves blank anything the record doesn't support, and opens the form for your review. When it's done, save it to the patient's chart in one click.

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Sources for this guide

Questions

Questions we hear a lot.

Is a bone density test covered by MSP in BC?

Diagnostic BMD is an MSP insured service for patients at moderate or higher risk of fracture, as defined in the BC osteoporosis guideline, when the test is likely to alter treatment. Routine screening of people under 65 is not insured.

How often can a patient repeat a bone density scan?

For patients on osteoporosis medication, a repeat BMD isn't considered medically necessary before three years after the original measurement, and then only if it's likely to change management. The form lists exceptions, such as long-term glucocorticoid therapy and primary hyperparathyroidism.

Can a patient pay for a screening bone density scan?

Yes. The form has a non-diagnostic, patient-pay section for screening or follow-up that isn't clinically indicated. The patient pays the facility for the exam.

Who can refer to the BC Women's bone density clinic?

A primary care provider, such as a family physician or nurse practitioner. BC Women's asks for a fully completed requisition by fax and contacts the patient directly to book.

Is patient information secure?

Yes. Medulla has a SOC 2 Type II report from an independent auditor, is HIPAA, PIPEDA, and PHIPA compliant, and is built and hosted in Canada, so patient data stays in the country and never gets pasted into consumer AI tools. Everything is encrypted in transit and at rest. See how we protect patient data.

More questions? Browse help.medulla.ca.