MOH Requisition Requirements

A legible and thoroughly completed requisition will assist MLW in providing the correct tests and results in a timely manner. In order to avoid delays and errors in your patient’s laboratory testing please ensure the requisitions are properly completed.

Doctor Information

  • Full doctor name / address / Clinician addess
  • Contact number for urgent results
  • Doctor signature at bottom left – mandated by MOH
  • Date issued at bottom left – mandated by MOH



  • Requisitions are valid for 6 months from date issued
  • Standings orders for patient testing can only be issued for a 6 month interval, upon ending the patient will require a new requisition to resume testing


Copy to Physician

  • Please provide the full name of the practitioner to receive a report. If the report is to be faxed please provide the fax number as well as the name of the person whom the report is to be sent


Patient Information

  • Full legal name as it appears on the patients’ health card
  • Gender
  • Date of Birth
  • Provincial Health Card number / version code
  • Patients address including phone number


Test(s) Ordered

  • Check the preferred tests or (legibly) print the test name in the “other tests” section


Additional Forms

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