Get Canada Provincial Clinical Laboratory Microbiology Request Form 2021-2025

Completing the Canada Provincial Clinical Laboratory Microbiology Request Form online can streamline the process of submitting laboratory requests. This guide provides clear, step-by-step instructions to assist users in accurately filling out the form, ensuring all necessary information is included.

Follow the steps to complete the online form successfully.

1. Click ‘Get Form’ button to access the Canada Provincial Clinical Laboratory Microbiology Request Form and open it for editing.
2. Enter the address for non-PEI residents if applicable. Provide the necessary details such as street address, city, and postal code/zip. Ensure this section is filled out correctly to avoid any delays.
3. Fill in the specimen collection information. Input the name of the person who collected the specimen, along with the date and time of collection, formatted as YYYY/MMM/DD for the date and HH:MM for the time.
4. Specify the payment responsibility by selecting the appropriate option. Options include WCB, DVA, Self Pay Canadian, DND, RCMP, or Self Pay Non-Canadian. Make sure to include the Provincial Medicare number and its expiry date if applicable.
5. Enter the patient's date of birth in the required format YYYY-MMM-DD, along with their medical record number (MRN) for identification purposes.
6. Complete the patient’s contact information, including their phone number.
7. Include the name of the ordering physician or nurse practitioner and the location they are associated with. Fill in the province or state, and city where the ordering physician or NP practices.
8. Provide any necessary copies for out-of-province providers by including their full name and fax number.
9. Add a diagnosis if required. This information assists in the interpretation of the laboratory results.
10. Review the completed form for accuracy. Ensure all sections are filled out correctly and clearly before finalizing.
11. Once you are satisfied with the information entered, save any changes made to the form. You may also choose to download, print, or share the completed form as necessary.

Start filling out the Canada Provincial Clinical Laboratory Microbiology Request Form online today to ensure efficient processing of your laboratory requests.