What the HCV/HBV requisition is for
The form orders molecular testing for hepatitis C and hepatitis B at Public Health Ontario’s laboratory: HCV RNA viral load and genotyping, HBV DNA viral load and genotyping, and drug resistance testing for either virus. It is separate from the hepatitis serology you order on the general test requisition, which is where diagnosis starts.
PHO decides whether to run each test against the indication you tick. Requests outside the listed indications are rejected unless a PHO microbiologist approves them, and requests with incomplete information are rejected too. The form itself notes that drug resistance testing is for viral breakthrough or treatment failure and isn’t required before starting treatment.
Who completes it
The ordering health care provider completes the whole form. You must be authorized to order laboratory tests in Ontario, and the licence number field takes your OHIP billing number, CPSO number or other college registration number. In a clinic with rotating providers, the guide asks you to name the attending provider so results reach the right person.
How to fill in the requisition
Ordering Healthcare Provider Information and Copy to
Complete your name, licence number, address, telephone and fax. If another provider, lab or health unit needs the result, complete the Copy to fields as well. PHO advises against pre-populated requisitions, and if you use one, check that every field is still current.
Patient Information
Use the names exactly as they appear on the health card, and make sure the identifiers match the specimen label, or testing is cancelled. Don’t leave the health card number blank: write “not available” if it’s unknown. A positive result for a reportable disease goes to the health unit where the patient lives, so give a current address.
Test(s) Requested and Specimen Information
Tick the tests for each virus. Serum in a spun serum separator tube is the standard specimen, and unspun primary tubes are rejected. Record the date collected, which the guide flags as the field submitters miss most. “Other” specimen types need a PHO microbiologist’s approval before you send them.
Testing Indication(s) / Criteria
This section is mandatory, and HCV and HBV have separate lists. For HCV, choose from diagnostic, pre-treatment, on-treatment and post-treatment indications, including reinfection, point-of-care antibody positive, spontaneous clearance and infant diagnosis up to 18 months. For HBV, choose the treatment stage or a reason such as viral breakthrough, transplant, prenatal or occult infection. For a transplant recipient, PHO asks for the donor’s HBV status on the requisition.
Common reasons it’s rejected or delayed
- No testing indication, or an indication from the wrong virus’s list.
- Patient identifiers on the tube that don’t match the requisition.
- An unspun primary collection tube.
- An HBV viral load sent sooner than PHO’s minimum interval without approval.
- HBV genotype or resistance testing on a specimen whose viral load is below the limit of quantitation.
- A missing collection date.
Submitting and who pays
Send the specimen in a sealed biohazard bag with the requisition to PHO’s laboratory. HCV RNA turnaround is up to six business days from receipt. Results go to the provider named on the requisition, and detected HCV RNA is reported to the medical officer of health. Testing is an insured service, so the patient isn’t charged.