What the dermatopathology requisition is for
This requisition sends skin specimens, such as shave, punch and excisional biopsies, to LifeLabs for dermatopathology in Ontario. The Ontario laboratory requisition used for blood work says pathology needs its own form, and LifeLabs has separate requisitions for gastrointestinal, gynecologic and general surgical pathology. Use this one for skin.
Who completes it
The clinician who took the specimen completes and signs it. Office staff often fill in the patient and copy-to details. The patient doesn’t complete any part.
How to fill in the requisition
Requesting clinician and patient details
Enter your name, address, phone and billing number, and up to two clinicians for copies, with every field filled in. For the patient, give the health card number and version, gender, date of birth, chart number, phone, address, and names exactly as they appear on the health card. Use the same names on the container labels.
Date of clinical procedure
Enter the date you took the specimens, not the date the form was printed.
Specimens A to H
Each row is one container. Write the anatomic site precisely, for example left lateral malleolus rather than leg, and check the procedure: excision, punch, shave, curettage, or re-excision. Check alopecia for scalp biopsies done for hair loss and immunofluorescence when that study is needed. Label each container with the same letter as its row.
Clinical data
Give the diagnosis or differential for each specimen, and add what the pathologist can’t see: duration, change over time, prior treatment, and for a re-excision, the original diagnosis and margin status.
Container count and signature
Enter the total number of containers, to a maximum of eight, and sign the form.
Common reasons it’s delayed
- Containers not lettered to match the rows on the form.
- Site written as a region, such as back or arm, when several lesions came from it.
- No clinical data or differential.
- Patient names not matching the health card.
- Missing signature or billing number.
- More than eight containers on one requisition.
Submitting and who pays
The requisition travels with the specimens to LifeLabs. Unlike LifeLabs’ private-pay requisitions, it has no patient payment section. Medulla can suggest this requisition from the plan’s orders when the visit includes a skin biopsy.