What the surgical pathology requisition is for
This is LifeLabs’ general requisition for tissue sent for pathology in Ontario. Skin, gastrointestinal and gynecologic specimens have their own LifeLabs forms, so this one covers the rest, such as lipomas, cysts, lymph nodes, and breast tissue. The Ontario laboratory requisition says pathology needs a separate form from routine blood work.
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, gender, 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 anatomic site, side and procedure, for example excision of a right upper back subcutaneous mass.
Clinical data
Give the diagnosis or differential for each specimen, with the size, duration, and any imaging finding that led to the procedure.
Required for breast specimens
For every breast specimen, record the time it was removed from the body and the time it was placed into formalin, with AM or PM. These fields sit beside each lettered row and are marked required.
Container count and signature
Enter the total number of containers, up to eight, and sign.
Common reasons it’s delayed
- Breast specimens sent without the removal and formalin times.
- Skin, GI or gynecologic specimens sent on this form instead of their own.
- Containers not lettered to match the form.
- No side recorded for a paired organ or limb.
- 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 excision.