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F-SD-SCG-4000

COVID-19 and Respiratory Virus Test Requisition

Clinics that still have this form saved should replace it. Since January 5, 2026, Public Health Ontario rejects specimens sent with it and requires the General Test Requisition for all respiratory virus testing, including COVID-19, with symptoms and onset date clearly documented.

At a glance

Checked October 2026

Form number
F-SD-SCG-4000
Issued by
Public Health Ontario
Where
Ontario
Completed by
Ordering clinician
Format
Fillable PDF
Language
English

What the requisition was for

This form ordered COVID-19 and respiratory virus testing at Public Health Ontario’s laboratory. It asked for the ordering clinician, patient, travel and exposure history, tests requested, specimen type, patient setting, vaccination status and clinical information. LifeLabs still links it from its requisitions page, but PHO no longer accepts it.

What replaced it

Effective January 5, 2026, PHO requires its General Test Requisition for all respiratory virus testing, including COVID-19, and rejects specimens sent with this form. The requirements carried over: symptoms and the date of symptom onset must be clearly documented, and specimens from asymptomatic patients or without appropriate clinical information aren’t tested.

Who completes the replacement

The ordering clinician completes the General Test Requisition. The patient doesn’t complete any part.

What PHO needs on the General Test Requisition

PHO asks for all fields to be completed, including the test requested and the indication for testing, clinical information with the symptom onset date, any medical condition that raises the risk of severe illness, the patient setting such as inpatient, ICU or congregate living, the specimen type and collection date, and an outbreak number if there is one. If the patient qualifies for publicly funded testing under Ministry of Health guidance, say so on the requisition.

Label the specimen container with the patient’s first and last name, the collection date, and one other unique identifier, such as date of birth or health card number. Send one swab per transport tube.

Common reasons specimens are rejected

  • Sent with the retired COVID-19 and Respiratory Virus Test Requisition.
  • No symptoms or symptom onset date documented.
  • The patient was asymptomatic.
  • Container labelled without a second identifier.
  • More than one swab in a single transport tube.

Submitting and who pays

Specimens go to a PHO laboratory with the General Test Requisition. When the patient is eligible for publicly funded testing under Ministry of Health guidance, PHO requires you to indicate it on the requisition.

Get the official form

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

Official page ↗ PDF ↗

Medulla Forms

Fill F-SD-SCG-4000 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.

Free 1-month trial. No credit card required.

Sources for this guide

Questions

Questions we hear a lot.

Can I still use the COVID-19 and Respiratory Virus Test Requisition?

No. PHO stopped accepting specimens submitted with it on January 5, 2026. Use PHO's General Test Requisition for all respiratory virus testing, including COVID-19.

Can asymptomatic patients be tested for COVID-19 at PHO?

No. PHO says asymptomatic patients have not been eligible since October 1, 2024, and their specimens are rejected. Specimens without appropriate clinical information aren't tested either.

Does PHO still run standalone COVID-19 PCR?

PHO says that from August 31, 2026, standalone COVID-19 PCR requests are replaced by its respiratory virus panels, FLUVID and MRVP, chosen by testing eligibility. Both panels include COVID-19.

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.