This regulation controls how laboratory and diagnostic imaging requisition forms may be provided, used, completed, approved, and filled out.
Laboratory Requisition Forms Regulation, M.R. 40/95 The Health Services Insurance Act , C.C.S.M. c. H35 Regulation 40/95 Registered March 13, 1995 bilingual version (HTML) Table of Contents Section 1 Definitions 2 Prohibition 3 Preprinted information 4 Form approved by minister 5 Laboratory tests to be requisitioned individually 6 Diagnostic imaging examinations to be requisitioned individually 7 Repeal Schedule Definitions 1 In this regulation, "Act" means The Health Services Insurance Act ; («  Loi  ») "diagnostic laboratory" means a laboratory as defined in section 119 of the Act, but does not include a laboratory that is not paid benefits for laboratory procedures under the Payment for Insured Medical Services Regulation ; (« laboratoire de diagnostic ») "health professional" means a physician or other health professional who is authorized by regulation to order laboratory tests or diagnostic imaging examinations; (« professionnel de la santé ») "tariff rate file" means the extended mainframe version of the Schedule to the " Payments for Insured Medical Services Regulation , Manitoba Regulation 73/2003" (commonly known as the Physician's Manual), which includes, without limitation, the prefix, effective date and three years of fees for each medical service. (« document tarifaire ») M.R. 44/2005 ; 209/2006 Prohibition 2 No diagnostic laboratory shall provide, and no health professional shall use, a laboratory or diagnostic imaging requisition form except in accordance with this regulation. M.R. 44/2005 ; 209/2006 Preprinted information 3(1) A laboratory requisition form provided by a diagnostic laboratory or used by a health professional may (a) be blank; (b) be lined; (c) contain a preprinted list of individual tests based on the tariff rate file approved by the minister from time to time; or (d) be blank or lined and have attached a preprinted list of individual tests based on the tariff rate file approved by the minister from time to time. M.R. 44/2005 ; 209/2006 3(2) A laboratory requisition form provided by a laboratory must contain (a) the preprinted information set out in Table 1, if it is a laboratory requisition form; and (b) the preprinted information set out in Table 2, if it is a diagnostic imaging requisition form. M.R. 209/2006 3(3) A laboratory requisition form must be completed by the requisitioning health professional. M.R. 44/2005 Form approved by minister 4 Before providing or using a laboratory or diagnostic imaging requisition form or making any modification to an existing form, the diagnostic laboratory or the health professional who provides or uses the form shall send a copy of it to the minister for approval. M.R. 44/2005 ; 209/2006 Laboratory tests to be requisitioned individually 5(1) A health professional who requisitions laboratory tests on a requisition form shall specify individual tests and shall not requisition tests in non-specific blocks such as "C.B.C.", "liver profile", "kidney profile" or "thyroid profile". M.R. 44/2005 5(2) A diagnostic laboratory shall not perform tests unless they are requisitioned in accordance with subsection (1). Diagnostic imaging examinations to be requisitioned individually 6 A health professional who requisitions diagnostic imaging examinations on a requisition form shall specify individual and specific diagnostic imaging examinations and indicate when additional views, diagnostic imaging or other examinations are medically required. M.R. 44/2005 ; 209/2006 Repeal 7 The Laboratory Requisition Forms Regulation , Manitoba Regulation 507/88 R, is repealed. SCHEDULE TABLE 1 MANITOBA HEALTH REGISTRATION/ HEALTH I.D. NO. _______________ REQUIRED Payment Agency Responsible: Manitoba Health requires that one of the following boxes be marked by the requisitioning health professional at the time the laboratory test(s) is ordered: □ Manitoba Health □ Workers Compensation Board □ Third Party Requirement – Specify □ Other – Specify Manitoba Health requires that a health professional who requisitions tests on this form must specify individual tests and must not requisition tests in non-specific blocks such as "C.B.C.", "liver profile", "kidney profile", or "thyroid profile". A laboratory will not perform tests that are requisitioned in non-specific blocks. TABLE 2 MANITOBA HEALTH REGISTRATION/ HEALTH I.D. NO. _____________REQUIRED Payment Agency Responsible: Manitoba Health requires that one of the following boxes be marked by the requisitioning health professional at the time the diagnostic imaging examination(s) is ordered: □ Manitoba Health □ Workers Compensation Board □ Third Party Requirement – Specify □ Other – Specify Manitoba Health requires that a health professional who requisitions diagnostic imaging examinations on this form must specify individual and specific diagnostic imaging examinations. Additional views, examinations or further diagnostic imaging examinations may be performed as medically required. Comparison diagnostic images cannot be claimed in addition to the diagnostic imaging examinations performed. M.R. 44/2005 ; 209/2006
