What the ONPSC 305 A is for
The form records why you are ordering a CEA, so Dynacare can claim the test under Cancer Care Ontario’s policy. CEA is funded for monitoring established colorectal cancer and metastatic breast cancer, and not as a general screen. It travels with the usual lab requisition and does not replace it. LifeLabs uses its own CEA requisition for the same criteria.
Who completes it
The ordering clinician completes and signs the whole form. It has no patient section. The patient brings it to the collection centre with the requisition.
How to fill in the form
Patient details
Name, address, and health insurance number. These must match the lab requisition so the authorization attaches to the right specimen.
Reason for ordering
Tick one of four funded reasons: pre-operative for a clinical diagnosis of colorectal cancer, adjuvant therapy or follow-up for stage II or III colorectal cancer, treatment of metastatic colorectal disease, or treatment of metastatic breast cancer. The two metastatic options state that CEA is the most appropriate way to monitor response. If none applies, tick the last box, which tells the lab to proceed and invoice the patient.
Clinician signature
Sign, print your name, and add a telephone number and the date. An unsigned form leaves the test unfunded.
Common reasons it’s sent back
- No form sent with the requisition, so the lab can’t claim the test.
- A repeat test less than 28 days after the last one.
- Metastatic colorectal monitoring repeated more often than every two treatment cycles.
- No reason ticked, or a reason that doesn’t match the clinical picture.
- Missing signature or printed name.
Submitting and who pays
The patient takes the form and the requisition to a Dynacare patient service centre. A test that meets a funded criterion costs the patient nothing. A test ordered outside the criteria is invoiced to the patient.