On this page you will find our requisition forms, available for download. Before submitting, be sure that the requisition is neatly completed in full and all sample specifications are followed. Incomplete or illegible requisitions will delay the return of results.
Metabolic Diseases & Genome Diagnostics requisition
Genome Diagnostics requisitions
Genome Diagnostics (with Billing) form
For patients with an Ontario Health Card: complete only the first five pages. For patients without an Ontario Health Card: complete all six pages
Cancer Testing (with Billing) form
Prior approval by Dr. Adam Shlien is required. Email email@example.com.
As of November 1, 2020, Constitutional Karyotype Analysis is restricted to paediatric patients (< 18 years of age), or familial follow-up of paediatric probands. Test requests received for non-paediatric cases as of this date will no longer be accepted.
Molecular Pathology requisition
- Name of the individual and date of birth
- Disease indication and reason of referral'
- Clinical and family history information pertaining to the disease indication
- Reason for requesting expedited testing, including the gestational age and/or LMP date for pregnancy samples
- If other family members have had testing in the Genome Diagnostics, please indicate their name, date of birth, and/or SickKids laboratory number. Please also include information about the familial mutation, if known.
- Specimens should be packaged in compliance with IATA P.I. 650 shipping standards. The outside of the package should have a label (see below) indicating 'Non-biohazardous, Non toxic material' and of no commercial value.
- The specimen should be shipped on a Monday, Tuesday or Wednesday so that the Genome Diagnostics Laboratory will receive the specimen within 24 to 48 hours after collection. If there is a delay in the shipping of specimen (i.e.>48 hours), the sample should be placed in the refrigerator and shipped to the Genome Diagnostics Laboratory on ice. Please call to inform us when the samples are being sent so that we can contact you if they do not arrive as expected.
The Department of Paediatric Laboratory Medicine
The Hospital for Sick Children
170 Elizabeth Street, Room 3642 (Rapid Response Lab)
Toronto, ON, M5G 1H3
Prenatal Samples (Cultured Amniocytes and Chorionic Villi)
- Please indicate RUSH/STAT on the outside of the package.
- Contact Leslie Steele, Genetics Coordinator at firstname.lastname@example.org to provide patient, disease and sample information prior to sending a prenatal sample.
- Call 416-813-7200 x1 and provide the courier’s name and waybill number so that samples that do not arrive can be traced.
Lab & Testing Services
Learn more about the Department of Paediatric Laboratory Medicine.
Browse our test catalogue.