What the SKIIN Holter requisition is for
It orders ambulatory ECG monitoring with a SKIIN chest band instead of a conventional Holter fitted at a lab. Myant Health mails a kit with a return envelope and instructions, and the patient wears it at home. You can also request a virtual cardiology consult if the result is abnormal. LifeLabs’ cardiac services requisition covers a conventional Holter and ambulatory blood pressure monitoring.
Who completes it
The ordering physician completes the form and signs it. The patient doesn’t fill in a section, but the form tells you to give them a copy, which has Myant Health’s contact details and what to expect.
How to fill in the requisition
Patient information
Name, date of birth, sex, health insurance number, address, phone and email. Tick whether the patient consents to be contacted by Myant Health. Without consent, the study can’t go ahead.
Physician information
Your name, address, phone, fax, email, billing code, licence number and signature. Tick the box if you want a virtual cardiologist consult for an abnormal result.
Reason for referral
Tick rule out atrial fibrillation or flutter, known AF or flutter, TIA or stroke, chest pain, dizziness, shortness of breath, syncope, palpitations, or other.
Current medications and contraindications
Tick the patient’s current medications from the list, which includes ACE inhibitors, ARBs, beta-blockers, statins, ASA and oral anticoagulants, and check the contraindications before you fax. A pacemaker, ICD, pregnancy, or age under 18 rules out the study.
Common reasons it’s delayed
- Consent to contact left blank or ticked no.
- An email or phone number Myant can’t reach.
- A contraindication present.
- Faxed without the physician’s signature or licence number.
Submitting and who pays
Fax the requisition to Myant Health at the number on the form and give the patient a copy. Myant contacts the patient and mails the kit. All questions about the study and its results go to Myant Health.