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Physician Form

General Test Requisition Form

A downloadable Physician form for healthcare professionals.
Auto-fill with HeidiBrowse templates

Specialty

Physician

Downloads

17 times

Type

Form

Last edited

7/24/2026

Created by

Heidi Team

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About this form

The General Test Requisition Form is used to document clinical test requisitions in a structured and consistent manner. It captures required clinic and clinician details, relevant patient information, and the specific tests or procedures requested, supporting clarity and completeness in submissions. Completing the General Test Requisition Form in Heidi supports organised documentation, reduces the risk of missing information, and assists with alignment with clinical and administrative requirements.

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Frequently asked questions

What is the purpose of the General Test Requisition Form PDF?

The purpose of the General Test Requisition Form is to provide authorized Ontario health care providers with a standardized document for submitting specimens to Public Health Ontario's laboratory. This form is used for infectious disease, hepatitis serology, and public health testing. It is designed to capture all necessary clinic, clinician, patient, and specimen details in a structured way to ensure clarity and completeness. Using this standardized form supports organized documentation, reduces the risk of missing information, and helps meet clinical and administrative requirements for testing.

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Who uses the General Test Requisition Form PDF?

As an authorized health care provider in Ontario, you use the General Test Requisition Form to order laboratory tests from Public Health Ontario. You are responsible for completing all submitter, patient, specimen, and test sections of the form. For hospitals and laboratories, the Laboratory Director may be listed as the submitter, while in clinics with rotating providers, the attending provider's name is used. You are also responsible for verifying specimen requirements before submission and for sharing results with other providers or health units if needed.

What is included in a General Test Requisition Form PDF?

A General Test Requisition Form includes all the required details for the submitting provider, the patient, the specimen, and the specific tests being requested.

  • Submitter details: full name, license number, facility name, address, and contact information
  • Copy-to provider or health unit information
  • Patient details: health card number, medical record number, date of birth, sex, full name, address, and telephone
  • Investigation or outbreak number, if applicable
  • Specimen details: date collected, submitter lab number, and specimen type
  • Patient setting: clinic/community, inpatient, ICU, ER, or other
  • Testing indication or criteria
  • Signs and symptoms with onset date
  • Relevant exposures, including needlestick source
  • Relevant travel history
  • Specific assay names as per the current test directory
  • Hepatitis serology section for routine hepatitis A, B, or C testing

Common Problems of Completing General Test Requisition Form PDFs

Assay Names Requiring Exact Terminology

The form requires each test assay to be entered individually and legibly, exactly as it appears in the public health authority's current test directory. Using a generic description or a slightly different name can lead to processing delays or rejection. The authority will not add tests to a previously submitted specimen except in exceptional circumstances. Ensuring every test is named correctly according to the directory is a frequent point of friction, demanding precision and familiarity with the latest test list.

Specific Fields That Delay Test Approval

Several specific fields on the form are frequently missed, which can cause delays in test approval or processing. For instance, if signs or symptoms are noted, the corresponding onset date field must be completed. The patient health card number field cannot be left blank; if the number is unknown, the form requires you to write "not available" instead. Forgetting these small but critical details can result in the form being returned or testing being put on hold pending clarification.

Wrong Form Used for Specific Tests

This general requisition has specific exclusions. It is not the correct form for ordering tests for HIV, respiratory viruses, or for submitting culture isolates and environmental samples. Public Health Ontario provides dedicated, separate requisitions for these specific test categories. Using this general form for one of the excluded tests will result in a delay or cancellation, as the specimen will need to be resubmitted with the correct paperwork. Verifying the right form is being used is an essential preliminary step.

Benefits of Using Heidi to Auto-Fill General Test Requisition Form PDFs

Your Submitter Details, Consistent and Correct

Instead of manually entering your provider and facility details on every form, Heidi pre-populates the entire submitter section for you. It pulls your name, OHIP billing or CPSO number, and your lab or facility’s name, address, and contact details directly from your provider profile. This ensures your requisitions are always identified consistently and accurately, reducing the chance of errors that can delay test reporting or cause communication issues.

Key Patient Information Pulled From the Record

Finding and transcribing patient details for every requisition adds up. Heidi prefills the patient information block by pulling the patient’s health card number, date of birth, sex, name as per their health card, address, and telephone from their profile. It also surfaces relevant details like documented exposures and travel history from your clinical notes. As a starting point for your review, this reduces manual data entry and minimizes transcription errors.

Clinical Context Applied Directly to the Form

Connecting your clinical reasoning to the form’s requirements is often a separate documentation step. Heidi bridges this gap by populating key fields from the clinical context. It surfaces the symptom onset date from your notes to fill the required onset date field. It also pre-populates the testing indication section from your documented clinical reasoning, ensuring the justification on the form matches the logic in your record. You review and confirm the output before it is finalized.

How to use this form

1

Auto-fill with Heidi

Click "Auto-fill Form with Heidi" to open the form in Heidi and complete the fields straight from your note, no copying and pasting.

2

Review and edit

Check the pre-filled details and make any changes before finalising the form.

3

Download or save

Download the completed form or save it directly into your patient records and workflows.

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