What the requisition is for
This is the Ontario Cervical Screening Program requisition for routine cervical screening. It orders the primary HPV test, which includes reflex cytology and partial genotyping when the result is positive, all from one sample. In one narrow case it orders cytology alone.
It is often confused with the colposcopy version, which looks almost the same but is used only by colposcopists for follow-up of screening abnormalities. Screening or vaginal vault testing done in a gynecology clinic still uses this screening requisition.
Who completes it
The requester completes the whole form: a physician, midwife or nurse practitioner, with a CPSO or CNO number and billing number. The patient completes nothing, but verify the mailing address with them, since the program sends result letters there.
How to fill in the requisition
Requester and patient information
Tick one requester type, then enter your details and any copy-to primary care provider. Enter the patient’s name, date of birth, sex and OHIP number as they appear on the health card, or use a label. Dynacare notes that the provider is responsible for validating the patient information before signing.
Testing Indication for Cervical Screening
Tick one indication. Under the HPV test, the choices are average-risk screening every five years, immunocompromised screening every three years, a two-year follow-up after an HPV-positive result for other high-risk types with normal or low-grade cytology, two-year follow-up after colposcopy, and a one-time vault test after hysterectomy for those who qualify. Cytology alone is only for a repeat after an HPV-positive result with unsatisfactory cytology. The form defines who counts as immunocompromised.
Specimen
Tick the site, add any special considerations for cytology interpretation such as an IUD, pregnancy or postpartum status, menopausal or transition-related hormone therapy, and give the collection date and first day of the last menstrual period. Sign and date the requester verification.
Common reasons it’s rejected or delayed
- The wrong requisition: the general lab form, a hospital form, or the colposcopy version.
- More than one testing indication ticked.
- Patient details that don’t match the health card or the specimen label.
- A SurePath specimen instead of ThinPrep.
- No collection date, or no requester signature.
Submitting and who pays
Send the requisition with the specimen through your clinic’s usual lab courier. The OCFP summary lists LifeLabs, Dynacare and North Bay Regional Health Centre as the labs performing program tests, and they also supply collection kits. Testing is publicly funded for eligible patients with valid OHIP coverage. Medulla can suggest this requisition when screening is in the visit plan.