What the non-gynecologic cytology requisition is for
This form sends cytology specimens that aren’t cervical or vaginal to LifeLabs in Ontario. Its sections cover urine, respiratory specimens, body fluids, thyroid, breast, lymph node, salivary gland, and fine needle aspiration biopsies of organs such as kidney, lung, liver and pancreas. Tissue biopsies go on a surgical pathology requisition instead.
Who completes it
The ordering clinician completes it. The form has no signature line, but it does need your billing number. The patient doesn’t complete any part.
How to fill in the requisition
Requesting clinician and patient details
Enter your name, address, billing number and phone, and up to two copy-to clinicians with every field filled in. Give the patient’s health card number and version, sex, date of birth, chart number, phone, address, and names as they appear on the health card.
Payer, collection date and specimen count
Check OHIP/Insured, Third Party/Uninsured, or WSIB. Enter the specimen collection date and the number of specimens submitted.
Specimen type
Check the section that matches the specimen. Urine asks whether it was voided, catheterized or a bladder wash. Respiratory asks for sputum, bronchial brush or bronchial wash. Fluids asks for pleural, peritoneal, CSF or other. Thyroid, breast, lymph node and salivary gland each ask for the side and site, and whether it’s a cyst, nodule, mass or discharge. Fill in the site and side line for anything other than a single obvious source.
Clinical history and remarks
Give the reason for the test and what you’re looking for, for example painless gross hematuria in a smoker, or a 2 cm thyroid nodule with suspicious features on ultrasound. The form notes that inadequate clinical information may hinder diagnosis.
Common reasons it’s delayed
- No side recorded for breast, thyroid, lymph node or salivary specimens.
- A cervical or vaginal sample sent on this form.
- No payer box checked.
- Clinical history left blank.
- Number of specimens not entered.
Submitting and who pays
The requisition travels with the specimen to LifeLabs. The payer box sets who is billed: OHIP for insured patients, a third party or the patient when uninsured, or WSIB for a work-related claim.