What the Newborn CMV requisition is for
Ontario’s newborn screen includes CMV. When it detects CMV DNA, the result needs confirming on a fresh specimen, and this one-page requisition orders that test: a qualitative CMV PCR on the baby’s urine at Public Health Ontario’s laboratory. It is a dedicated form, so it carries a test code for the newborn screen follow-up and has no other tests to choose.
The form is easy to confuse with the General Test Requisition, which covers every other CMV PCR request, including testing of immunocompromised or critically ill patients.
Who completes it
The ordering physician completes the whole form, giving their initial, surname and OHIP or CPSO number. A second doctor or clinic can be copied on the result in the cc fields. The patient has no part to fill in.
How to fill in the requisition
1. Ordering Physician Information and 2. Patient Information
Give your details and the date ordered, then the infant’s health number, name, address, date of birth and sex. Label the urine container with the infant’s first and last name, the collection date and one other identifier, such as the date of birth or health card number, and make sure they match the form.
3. Test(s) Requested and 4. Specimen Type
CMV PCR is the only test on the form. Tick urine. Choose Other only after PHO approves the specimen type. Tick the patient setting: physician office or clinic, ward, ICU, emergency department or institution.
5. Reason for Test and Clinical Information
The reason is preset to follow-up confirmation of CMV DNA detection on the newborn screen. Record the collection date and onset date, then tick the clinical findings that apply: asymptomatic, microcephaly, IUGR, respiratory symptoms, fever, rash, encephalitis or meningitis, or maternal CMV in pregnancy. Add anything else relevant in the free-text field.
Common reasons it’s delayed
- A blood or serum specimen, which PHO won’t accept for CMV PCR.
- Labels on the container that don’t match the requisition.
- A missing collection date.
- An unapproved specimen type under Other.
- Urine stored warm, or held too long before shipping.
Submitting and who pays
Seal the container in a biohazard bag with the requisition and ship it to PHO’s laboratory on ice packs. Results go to the ordering physician and anyone copied on the form. PHO only performs insured services under Ontario’s Health Insurance Act, so the family isn’t charged.