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PHRQ_HVS_0001F

Serology Screening Requisition

Use this requisition to order serology at the BC Centre for Disease Control's Public Health Laboratory, from routine prenatal screening to hepatitis panels after a needlestick. The reason for test and the panel you pick decide what the lab runs and how many tubes it needs.

At a glance

Checked October 2026

Form number
PHRQ_HVS_0001F
Issued by
BCCDC Public Health Laboratory (PHSA)
Where
British Columbia
Completed by
Ordering practitioner
Format
Fillable PDF
Language
English

What the serology screening requisition is for

This form orders antibody and antigen testing at the Public Health Laboratory: prenatal screening, perinatal syphilis, routine syphilis and HIV, hepatitis A, B and C serology, hepatitis C PCR, and immunity or acute serology for common viral and parasitic infections. Version 1.0 dates from August 2026. Swab and fluid testing for viruses goes on the separate virology requisition.

Who completes it

The ordering practitioner completes and signs it. The lab fills in the date received. Highlighted fields are mandatory.

How to fill in the requisition

Section 1: Patient and provider information

Give the personal health number, name, date of birth, sex, address and contact number, with the collection date and time. The container and requisition need two matching unique identifiers. Practitioners who work at more than one location should give the address for report delivery. Each practitioner listed under additional copies, up to three, receives the report.

Section 2: Clinical information

Choose the reason for test: needlestick injury, outbreak or cluster, prenatal, or other. Tick rash, STI contact or STI symptoms where they apply, and give recent travel and the onset date. The form asks you to fill this in as completely as you can.

Section 3: Tests requested

Pick from prenatal screening (anti-HCV, HIV, HBsAg, rubella IgG, first-trimester syphilis), perinatal syphilis at more than 35 weeks or delivery, routine syphilis, non-prenatal HIV, the hepatitis panels and single markers, hepatitis C PCR for treatment, and other serology by immunity or acute. List anything else under other tests and check the eLab Handbook for its sample requirements.

Common reasons it’s delayed

  • Mismatched identifiers between container and requisition.
  • A prenatal panel sent with one tube when the form asks for two.
  • Hepatitis C PCR requested on serum instead of EDTA plasma.
  • No reason for test, so the lab can’t place the request in context.
  • An acute IgM request with no onset date or symptoms.

Submitting and who pays

The samples and requisition go to the Public Health Laboratory at 655 West 12th Avenue, Vancouver. The report goes to the ordering practitioner and any copy recipients. The requisition has no billing section.

Get the official form

Download the current version from BCCDC Public Health Laboratory (PHSA) each time. Forms change without notice, and an old edition can be returned.

Official page ↗ PDF ↗

Medulla Forms

Fill PHRQ_HVS_0001F 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.

How many tubes does prenatal screening need?

The form asks for two serum separator tubes for prenatal testing. Perinatal syphilis, HIV and hepatitis serology each need one serum separator tube, and so does any combination of syphilis, HIV, hepatitis and other serology.

Where do I order HCV RNA or genotyping?

On this requisition, under Hepatitis C PCR, with one EDTA plasma (lavender-top) tube. The virology requisition sends hepatitis C RNA requests back to this form.

Which hepatitis panel should I pick after a needlestick injury?

Tick needlestick injury as the reason for test, then choose the panel that matches your question. The form offers acute and chronic panels of undefined etiology, a hepatitis B screen panel and single markers such as HBsAg or anti-HBs for immune status.

Can I order measles or varicella immunity on this form?

Yes. Other serology lists IgG for CMV, EBV, measles, mumps, parvovirus B19, rubella, toxoplasma and varicella, and IgM for the acute versions of most of them.

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.