What the GI pathology requisition is for
This requisition sends gastrointestinal tissue, such as polyps and mucosal biopsies, to LifeLabs for pathology in Ontario. The Ontario laboratory requisition says pathology needs its own form, and LifeLabs splits pathology by specimen type, with separate forms for skin, gynecologic and other surgical specimens.
Who completes it
The clinician who performed the procedure completes and signs it. 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, plus up to two copy-to clinicians with all fields filled in. Give the patient’s health card number and version, gender, date of birth, chart number, phone, address, and names as they appear on the health card.
Date of clinical procedure
Enter the date of the endoscopy or procedure.
Specimens A to H
Each row is one container, lettered to match. Write the anatomic site and procedure precisely, such as polypectomy at 30 cm or random biopsies of the right colon, and keep separate sites in separate containers so findings can be localized.
Clinical data and endoscopic findings
In clinical data, give the indication and differential, such as chronic diarrhea with query microscopic colitis or surveillance after prior adenoma. In endoscopic findings, describe what you saw at that site: polyp size and shape, ulceration, erythema, or normal mucosa.
Container count and signature
Enter the total number of containers, up to eight, and sign.
Common reasons it’s delayed
- Several sites pooled in one container when they needed to be reported separately.
- Containers not lettered to match the form.
- Endoscopic findings left blank.
- No indication or differential.
- Missing signature or billing number.
Submitting and who pays
The requisition travels with the specimens to LifeLabs. It has no patient payment section. Medulla can suggest this requisition from the plan’s orders when the visit includes a GI biopsy.