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Hereditary Cancer and Endocrine Requisition

This requisition orders germline testing at the Roy Romanow Provincial Laboratory in Regina, for panels from high-risk breast and ovarian to Lynch syndrome and pediatric cancer. The lab won't process a sample without a pedigree, and the clinical information you give shapes how variants are interpreted.

At a glance

Checked October 2026

Issued by
Saskatchewan Health Authority, Roy Romanow Provincial Laboratory
Where
Saskatchewan
Completed by
Ordering physician or genetic counsellor
Format
Fillable PDF
Language
English

What the requisition is for

The Roy Romanow Provincial Laboratory runs next-generation sequencing panels for inherited cancer and endocrine conditions. The panel covers the coding regions of 102 genes, with MLPA used for copy number changes in some genes. You order a named panel, a custom list of genes, or a test for a variant already known in the family. The full gene list for each panel is in the RRPL Compendium of Tests.

Who completes it

The ordering provider completes the requisition and signs the pre-test counselling statement on the back. That can be a physician or a genetic counsellor. The patient doesn’t fill in any part of it.

How to fill in the requisition

Patient, provider and copies

Give the patient’s name, address, HSN, date of birth and sex, and your name with middle initial, MSB number and return address. Add a fax number for a copy to another provider, such as the oncologist or genetics clinic. Fill in ethnic background, since some variants are more common in particular populations.

Test panel requested

Tick one panel that matches the phenotype. The form warns that careful panel selection speeds reporting and limits the variants of uncertain significance you’ll have to counsel on. For a narrower request, use the custom gene panel boxes, for example BRCA1 and BRCA2 only.

Reason for referral

Choose one: confirmation of diagnosis in a patient with signs or symptoms, predictive testing with none, carrier screening, DNA banking only, or a family study or positive control, which gets no report.

Clinical and family information

The lab needs a pedigree with ages of onset and family history to process the sample. Give the patient’s cancer type and age at diagnosis, relevant pathology, relatives already tested and their results, and attach the lab reports.

Review the ten points on the back with the patient, including that DNA left over is banked unless they say otherwise, that results may reveal non-paternity, and what the Genetic Non-Discrimination Act does and doesn’t protect. Then sign the attestation that you obtained verbal consent.

Common reasons it’s delayed

  • No pedigree, or a pedigree without ages of onset.
  • No clinical phenotype, which the lab needs to interpret variants.
  • A family variant request without the relative’s report attached.
  • Too little blood, or the wrong tube.
  • The consent attestation not signed.

Submitting and who pays

The patient takes the requisition to any test centre in Saskatchewan for the draw, and the sample goes to RRPL in Regina. Results come back to the ordering provider and any copy recipients listed. The requisition makes no mention of a charge to the patient.

Get the official form

Download the current version from Saskatchewan Health Authority, Roy Romanow Provincial Laboratory each time. Forms change without notice, and an old edition can be returned.

Official page ↗ PDF ↗

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Sources for this guide

Questions

Questions we hear a lot.

Where can the patient have blood drawn for RRPL hereditary cancer testing?

The requisition says blood can be drawn at any test centre in Saskatchewan. The lab needs two 4 ml EDTA lavender-top tubes, at least 8 ml in total, stored at 4°C and shipped at room temperature.

How long do results take?

The requisition says results may take up to six weeks. Its method notes add that confirming a finding can delay the report further.

What's needed to test for a variant already found in a relative?

Tick the family variant specific test, give the gene, variant, proband name and relationship, and attach a copy of the relative's genetic test report. The lab recommends a positive control if the relative was tested at a different lab.

Is written consent required?

The requisition asks the ordering physician or genetic counsellor to review ten pre-test counselling points with the patient and sign that verbal consent was obtained.

Is patient information secure?

Yes. Medulla has a SOC 2 Type II report from an independent auditor, is HIPAA, PIPEDA, and PHIPA compliant, and is built and hosted in Canada, so patient data stays in the country and never gets pasted into consumer AI tools. Everything is encrypted in transit and at rest. See how we protect patient data.

More questions? Browse help.medulla.ca.