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specino tests below and provide dagcs ns with patient's first & last name, DOB andlor PHN & site Baseline cardovascular risk assessment or folkow-up Lipd profe. Total, HOL S LDL Cholesterol Trigyoendes. fastng Folkow up of treatad hypercholesterclamia (Total, HOL & non HDL Cholesterol, tasting not aqured) Folow-up of treated hypercholesterolemia (ApoB only. tasting not required) Sel-pay ipid profle (non-MSP bilabie. lasting) HEPATITIS SEROLOGY Acute viral hopatitis undefined etiology Hepantis A (ant-HAV IgM) Hapatis B (HasAg anti-HBc) Hapantis CAntiHcV) O Chronic viral hopatitis undefined etiology Hepalitis DOsAg anti-HBc ant-HOs) Hepahtis C (ant HCV) THYROID FUNCTION For other tryroid imustigatiors, please crder specific tests below and provide diagnosis Investigation of hepatitis immune statue Hepantis A (ant-HAV. tota) Hepantis B (ant-HBe) Suspected Hypotyroidism (TSH frst -T4) V Suspected Hyperthyroidism (TSH fest T4, Ta) Monitor thyroid raplacement therapy (TSH only) Hopatitis markerts) OTHER CHEMISTRY TESTS V Sodium V Potassium V Albumin Ak phos (For other hapatits markers, please order specfic testis) below) V Creatinine /eGFR Calcium HIV SEROLOGY (Patent han legai right to choose nomnal or non nominal eporting O Nominal repoting ONon nominal neporting ALT Birubin V GGT VT. Protein Creatine knase (CK) PSA Kwn or sunpected prostake canoer (MSP blatk PSA scroening (seit pay) Urine OTHER TESTS Standing order requests - expiry & frequency must be indicated O EcG Fecal Ocult Blood (Age 50 - 74 asymptomatic qay) Copy to Colon Screening Program Fecal Occult Blood (Other indicators) act eam) Hair lodo SIGNATRE OF PHYSIC DATE SIGNED MARCH 2, 2021 ION PHLEBOTOMIST TELEPHONE REQUISITION RECEVED BY (employeeidatetime TONY under the authonity of the Fersonal Information Protection Act The personal nformationsused to provide medical servOS requested on this requstion The mant and discksed to heathcare practitioners involvad in providing care or when requred by lo Personal information is protocted from unauthoriaed use and tection Act and when applicatle the Freedom of nformation and Protection of Prhacy Act and mey be used and dedosed only as provided by those Acts

specino tests below and provide dagcs ns with patient's first & last name, DOB andlor PHN & site Baseline cardovascular risk assessment or folkow-up Lipd profe. Total, HOL S LDL Cholesterol Trigyoendes. fastng Folkow up of treatad hypercholesterclamia (Total, HOL & non HDL Cholesterol, tasting not aqured) Folow-up of treated hypercholesterolemia (ApoB only. tasting not required) Sel-pay ipid profle (non-MSP bilabie. lasting) HEPATITIS SEROLOGY Acute viral hopatitis undefined etiology Hepantis A (ant-HAV IgM) Hapatis B (HasAg anti-HBc) Hapantis CAntiHcV) O Chronic viral hopatitis undefined etiology Hepalitis DOsAg anti-HBc ant-HOs) Hepahtis C (ant HCV) THYROID FUNCTION For other tryroid imustigatiors, please crder specific tests below and provide diagnosis Investigation of hepatitis immune statue Hepantis A (ant-HAV. tota) Hepantis B (ant-HBe) Suspected Hypotyroidism (TSH frst -T4) V Suspected Hyperthyroidism (TSH fest T4, Ta) Monitor thyroid raplacement therapy (TSH only) Hopatitis markerts) OTHER CHEMISTRY TESTS V Sodium V Potassium V Albumin Ak phos (For other hapatits markers, please order specfic testis) below) V Creatinine /eGFR Calcium HIV SEROLOGY (Patent han legai right to choose nomnal or non nominal eporting O Nominal repoting ONon nominal neporting ALT Birubin V GGT VT. Protein Creatine knase (CK) PSA Kwn or sunpected prostake canoer (MSP blatk PSA scroening (seit pay) Urine OTHER TESTS Standing order requests - expiry & frequency must be indicated O EcG Fecal Ocult Blood (Age 50 - 74 asymptomatic qay) Copy to Colon Screening Program Fecal Occult Blood (Other indicators) act eam) Hair lodo SIGNATRE OF PHYSIC DATE SIGNED MARCH 2, 2021 ION PHLEBOTOMIST TELEPHONE REQUISITION RECEVED BY (employeeidatetime TONY under the authonity of the Fersonal Information Protection Act The personal nformationsused to provide medical servOS requested on this requstion The mant and discksed to heathcare practitioners involvad in providing care or when requred by lo Personal information is protocted from unauthoriaed use and tection Act and when applicatle the Freedom of nformation and Protection of Prhacy Act and mey be used and dedosed only as provided by those Acts

Essentials Health Info Management Principles/Practices
Essentials Health Info Management Principles/Practices
4th Edition
ISBN:9780357191651
Author:Bowie
Publisher:Bowie
Chapter6: Patient Record Documentation Guidelines: Inpatient, Outpatient, And Physician Office
Section6.5: Physician Office Record
Problem 4E
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Question
Which test is considered to be invalidated? 
FB
PT-INR
Sodium
HBsAg
2. What test will be affected by the current medication taken by the patient? *
Albumin
Potassium
Hematology profile
PT-INR
3. Which of the following is NOT collected from the patient? *
Serum
Stool
Urine
Vaginal discharge
4. For what reason is the patient indicated for GTT testing? *
The patient suffered from pulmonary embolism
The patient fasted
The patient is pregnant
The patient is taking warfarin
5. There is an error in the requisition form. Which of the following is it? *
The patient's test for dermatophytes
The patient's birthday
The patient's test for fecal occult blood
The physician's signature
6-7. Which of the following tubes will be involved in venipuncture based on the ordered tests? Check all that applies. *
RED
PURPLE
LIGHT BLUE
ROYAL BLUE
BLACK
GRAY
TAN
GREEN
Providence Outpatient Laboratory Requisition Vancouver čoastalHealth ORDERING PHYSICIAN, ADDRESS, MSP PRACTITIONER NUMBER HEALTH CARE Pting l Rarig How you want to be treated Laboratory Medicine (Anatomical Pathology requisitions - see separate form) OSWALDO, MD Grey highlighted fields must be completed to avoid delays in specimen collection and patient processing. For tests indicated with a grey tick boxO consult provincial guidelines and protocols (www.BCGuidelines.ca). O MSP Z PATIENT LOCUM FOR PHYSICIAN: Bill to: ICBC WorkSateBC O OTHER: PHN NUMBER ICBC/WorkSateBC/RCMP NUMBER 52641-121 123-123123-123 MSP PRACTITIONER NUMBER: SURNAME OF PATIENT FIRST NAME OF PATIENT 662314 GUEVERRA AMANDA SEX DD DOB YYYY 1984 13 Pregnant? YES Fasting? 7 PM It this is a STAT order please provide contact telophone number. h pc MM M NO 01 CHART NUMBER Copy to Physician/MSP Practitioner Number: 662314 TELEPHONE NUMBER OF PATIENT 426-XXXX ADDRESS OF PATIENT LEGARDA ST. PROVINCE BENGUET CITY/TOWN BAGUIO DIAGNOSIS CURRENT MEDICATIONS/DATE AND TIME OF LAST DOSE PULMONARY EMBOLISM COUMADIN 5g 7PM HEMATOLOGY URINE TESTS CHEMISTRY V Hematology profile V PT-INR O Ferritin (query iron deticiency) O Urine culture - list ourrent antibiotics V Glucose - fasting (see reverse tor patient instructions) V GTT - gestaional diabetas screen (50 g load, 1 hour post-load) O GTT - gestational diabetes confirmaion (75 g load, tasting. M On wartarin? Macroscopic + microscopic it dipstick positive Macroscopic + urine culture if pyuria or nitrite present V Macroscopic (dipstick) V Microsoopic O Special case (if ordered together) Pregnancy test 1 hour & 2 hour test) HFE - Hemochromatosis (check ONE box only) O Confirm diagnosis (ferritn first + TS, ± DNA testing) O sibing/perent is Cc282Y/C262Y homozygote (DNA testing) A Hemoglobin A10 O Albuminicreatinine ratio (ACR) - urina LIPIDS * one box only. For ofher lipid invesigations, please order specific tests below and provide diagnosis. MICROBIOLOGY - label all specimens with patient's first & last name, DOB and/or PHN & site V Baseline cardiovascular risk assessment or fellow-up (Lipid profile, Total, HDL & LDL Cholesterol Triglycerides, fasting Falow-up of treatad hyparcholesterolemia (Tatal, HDL & non-HDL Cholesterol, tasting not requred) Follow-up of treated hypercholesterolemia (ApoB only, fasting not required) Sel-pay ipid profile (non-MSP billable, lasting) ROUTINE CULTURE HEPATITIS SEROLOGY List current antibiotics: N/A O Acute viral hepatitis undefined etiology Hepatitis A (ant-HAV IgM) Throat V Blood O Urine Sputum Deep Wound Hapatitis B (HBsAg + anti-HBc) Hapatitis C (Anti-HCV) A Superficial Wound Site: LEFT ARM Chronic viral hepatitis undetined etiology Hapatilis B (HBsAg anti-HBe; anti-HBs) Hapatitis C (anti-HCv) Other: THYROID FUNCTION For olher fryroid invastigations, please order specilic tests below and provide diagnosis. VAGINITIS Investigation of hepatitis immune status Initial (smear for BV & yeast only) Chronic/tecurrent (smear, culture, trichomanas) Trichomonas testing Suspected Hypothyroidism (TSH first +-T4) V Suspected Hyperthyroidism (TSH first +-T4, +-T3) O Monitor thyraid replacement therapy (TSH only) Hepatitis A (anti-HAV, total) Hepatitis B (anti-HBs) Hopatitis marker(s) GROUP B STREP SCREEN (Pregnancy only) Penicilin alergy OTHER CHEMISTRY TESTS Vagino-anorectal swab V Albumin V Sodium V Potassium V Creatinine / eGFR Caloium Creatine kinase (CK) PSA - Known or suspected (For other hapatitis markers, please order spacific test(s) below) Alk phos CHLAMYDIA (CT) & GONORRHEA (GC) O CT & GC testing Sourcelsite: GC culture: HIV SEROLOGY V ALT (Patient has legal right to choose nominal or non-nominal reporting) O Nominal reporting 0 Non-nominal reportng Bilirubin Urethra Carvox O Urina V GT V T. Protein prostate cancer (MSP bilable) O Throat O Other: Rectal O PSA screening (selt-pay) OTHER TESTS STOOL SPECIMENS Standing order requests - expiry & treqquency must be indicated Fecal Occult Blood (Age 50 - 74 asymptomatic qay) Copy to Colon Screening Program V Fecal Occultl Blood (Cther indicakors) Yes History of bloody stools? C. ditcile testing Stool culture V Stool ova & parasite exam Slool ova å parasite (high risk, 2 samples) ECG DERMATOPHYTES V KOH prep (drect exam) V Hair Dermatophyte culture Spacimen: O skin Nail Sis: inguinal region Twaldo SIGNATURE OF PHYSICAN DATE SIGNED MYCOLOGY O Yeast MARCH 2, 2021 O Fungus TIME OF COLLECTION 9AM Site: DATE OF COLLECTION PHLEBOTOMIST TELEPHONE REQUISITION RECEIVED BY (employeeldatetime) MARCH 2, 2021 TONY INSTRUCTIONS TO PATIENTS (see reverse) Cther instructions: The personal intormation collected on this form is collected under the authority of the Rersonal ntormation Profection Act The personal information is used to provide medical services requested on this requistion. The intormation colected is used tor quality assurance management and disclosed to healthoare practitioners involved in providing care or when required by law. Personal intormation is probtocted from unauthorized use and disclosure in accordance with the Personal Information Protection Act and when applicable the Freedom of information and Protection of Privacy Act and may be used and disccsed only as provided by those Acts. 00070058 VCH.0120 MAY.2014 ODD DON
Transcribed Image Text:Providence Outpatient Laboratory Requisition Vancouver čoastalHealth ORDERING PHYSICIAN, ADDRESS, MSP PRACTITIONER NUMBER HEALTH CARE Pting l Rarig How you want to be treated Laboratory Medicine (Anatomical Pathology requisitions - see separate form) OSWALDO, MD Grey highlighted fields must be completed to avoid delays in specimen collection and patient processing. For tests indicated with a grey tick boxO consult provincial guidelines and protocols (www.BCGuidelines.ca). O MSP Z PATIENT LOCUM FOR PHYSICIAN: Bill to: ICBC WorkSateBC O OTHER: PHN NUMBER ICBC/WorkSateBC/RCMP NUMBER 52641-121 123-123123-123 MSP PRACTITIONER NUMBER: SURNAME OF PATIENT FIRST NAME OF PATIENT 662314 GUEVERRA AMANDA SEX DD DOB YYYY 1984 13 Pregnant? YES Fasting? 7 PM It this is a STAT order please provide contact telophone number. h pc MM M NO 01 CHART NUMBER Copy to Physician/MSP Practitioner Number: 662314 TELEPHONE NUMBER OF PATIENT 426-XXXX ADDRESS OF PATIENT LEGARDA ST. PROVINCE BENGUET CITY/TOWN BAGUIO DIAGNOSIS CURRENT MEDICATIONS/DATE AND TIME OF LAST DOSE PULMONARY EMBOLISM COUMADIN 5g 7PM HEMATOLOGY URINE TESTS CHEMISTRY V Hematology profile V PT-INR O Ferritin (query iron deticiency) O Urine culture - list ourrent antibiotics V Glucose - fasting (see reverse tor patient instructions) V GTT - gestaional diabetas screen (50 g load, 1 hour post-load) O GTT - gestational diabetes confirmaion (75 g load, tasting. M On wartarin? Macroscopic + microscopic it dipstick positive Macroscopic + urine culture if pyuria or nitrite present V Macroscopic (dipstick) V Microsoopic O Special case (if ordered together) Pregnancy test 1 hour & 2 hour test) HFE - Hemochromatosis (check ONE box only) O Confirm diagnosis (ferritn first + TS, ± DNA testing) O sibing/perent is Cc282Y/C262Y homozygote (DNA testing) A Hemoglobin A10 O Albuminicreatinine ratio (ACR) - urina LIPIDS * one box only. For ofher lipid invesigations, please order specific tests below and provide diagnosis. MICROBIOLOGY - label all specimens with patient's first & last name, DOB and/or PHN & site V Baseline cardiovascular risk assessment or fellow-up (Lipid profile, Total, HDL & LDL Cholesterol Triglycerides, fasting Falow-up of treatad hyparcholesterolemia (Tatal, HDL & non-HDL Cholesterol, tasting not requred) Follow-up of treated hypercholesterolemia (ApoB only, fasting not required) Sel-pay ipid profile (non-MSP billable, lasting) ROUTINE CULTURE HEPATITIS SEROLOGY List current antibiotics: N/A O Acute viral hepatitis undefined etiology Hepatitis A (ant-HAV IgM) Throat V Blood O Urine Sputum Deep Wound Hapatitis B (HBsAg + anti-HBc) Hapatitis C (Anti-HCV) A Superficial Wound Site: LEFT ARM Chronic viral hepatitis undetined etiology Hapatilis B (HBsAg anti-HBe; anti-HBs) Hapatitis C (anti-HCv) Other: THYROID FUNCTION For olher fryroid invastigations, please order specilic tests below and provide diagnosis. VAGINITIS Investigation of hepatitis immune status Initial (smear for BV & yeast only) Chronic/tecurrent (smear, culture, trichomanas) Trichomonas testing Suspected Hypothyroidism (TSH first +-T4) V Suspected Hyperthyroidism (TSH first +-T4, +-T3) O Monitor thyraid replacement therapy (TSH only) Hepatitis A (anti-HAV, total) Hepatitis B (anti-HBs) Hopatitis marker(s) GROUP B STREP SCREEN (Pregnancy only) Penicilin alergy OTHER CHEMISTRY TESTS Vagino-anorectal swab V Albumin V Sodium V Potassium V Creatinine / eGFR Caloium Creatine kinase (CK) PSA - Known or suspected (For other hapatitis markers, please order spacific test(s) below) Alk phos CHLAMYDIA (CT) & GONORRHEA (GC) O CT & GC testing Sourcelsite: GC culture: HIV SEROLOGY V ALT (Patient has legal right to choose nominal or non-nominal reporting) O Nominal reporting 0 Non-nominal reportng Bilirubin Urethra Carvox O Urina V GT V T. Protein prostate cancer (MSP bilable) O Throat O Other: Rectal O PSA screening (selt-pay) OTHER TESTS STOOL SPECIMENS Standing order requests - expiry & treqquency must be indicated Fecal Occult Blood (Age 50 - 74 asymptomatic qay) Copy to Colon Screening Program V Fecal Occultl Blood (Cther indicakors) Yes History of bloody stools? C. ditcile testing Stool culture V Stool ova & parasite exam Slool ova å parasite (high risk, 2 samples) ECG DERMATOPHYTES V KOH prep (drect exam) V Hair Dermatophyte culture Spacimen: O skin Nail Sis: inguinal region Twaldo SIGNATURE OF PHYSICAN DATE SIGNED MYCOLOGY O Yeast MARCH 2, 2021 O Fungus TIME OF COLLECTION 9AM Site: DATE OF COLLECTION PHLEBOTOMIST TELEPHONE REQUISITION RECEIVED BY (employeeldatetime) MARCH 2, 2021 TONY INSTRUCTIONS TO PATIENTS (see reverse) Cther instructions: The personal intormation collected on this form is collected under the authority of the Rersonal ntormation Profection Act The personal information is used to provide medical services requested on this requistion. The intormation colected is used tor quality assurance management and disclosed to healthoare practitioners involved in providing care or when required by law. Personal intormation is probtocted from unauthorized use and disclosure in accordance with the Personal Information Protection Act and when applicable the Freedom of information and Protection of Privacy Act and may be used and disccsed only as provided by those Acts. 00070058 VCH.0120 MAY.2014 ODD DON
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