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Specimen CollectionxBiochemistryxHematologyxViral Hepatitis (check one only)Glucose Random FastingCBCA cute HepatitisHbA1 CProthrombin Time (INR)Chronic HepatitisCreatinine (eGFR)ImmunologyImmune Status / Previous ExposureSpecify: Hepatitis A Hepatitis B Hepatitis Cor order individual hepatitis tests in the Other Tests section belowUric Acid Pregnancy Test (Urine)SodiumMononucleosis ScreenPotassiumRubellaALTP renatal: ABO, RhD, Antibody Screen(titre and ident. if positive)Alk. PhosphataseProstate Specifi c Antigen (PSA)BilirubinRepeat Prenatal AntibodiesTotal PSA Free PSAI nsured Meets OHIP eligibility criteriaUninsured Screening: Patient responsible for paymentAlbuminMicrobiology ID & Sensitivities(if warranted)Lipid Assessment (includes Cholesterol, HDL-C, Triglycerides, calculated LDL-C & Chol/HDL-C ratio; individual lipid tests may be ordered in the Other Tests section of this form )CervicalVaginalVitamin D (25-Hydroxy)Albumin / Creatinine Ratio, UrineVaginal / Rectal Group B StrepInsured - Meets OHIP eligibility criteria:osteopenia; osteoporosis; rickets;renal disease; malabsorption syndromes;medicatio
Specimen Collection x Biochemistry x Hematology x Viral Hepatitis (check one only) Glucose Random FastingCBCAcute Hepatitis HbA1C Prothrombin Time (INR) Chronic Hepatitis
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