What the gynecologic surgical pathology requisition is for
This requisition sends gynecologic tissue to LifeLabs for pathology in Ontario, such as endometrial biopsies, cervical biopsies and polyps. Cervical screening is a different test with its own requisitions. The Ontario laboratory requisition used for blood work also says pathology and cytology each need their own form.
Who completes it
The clinician who took the specimen 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, date of birth, chart number, phone, address, and names as they appear on the health card.
Date of clinical procedure
Enter the date you took the specimens.
Specimens A to H
Each row is one container, lettered to match. Name the site and procedure, for example endometrial pipelle biopsy, or cervical biopsy at 12 o’clock taken at colposcopy.
Clinical data
Give the diagnosis or differential for each specimen, and the history that changes the reading: last menstrual period or menopausal status, abnormal bleeding, hormone therapy or IUD, and for a cervical biopsy, the screening result that led to it.
Container count and signature
Enter the total number of containers, up to eight, and sign.
Common reasons it’s delayed
- A Pap or HPV sample sent on this form instead of a cytology requisition.
- No menopausal status or bleeding history for an endometrial biopsy.
- Containers not lettered to match the form.
- Patient names not matching the health card.
- 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 an endometrial or cervical biopsy.