Make an Outpatient Referral
To make an outpatient referral to an approved laboratory facility for an MSP funded laboratory test, complete the following steps:
1. Use the Standard Out-Patient Laboratory Requisition (SOPLR) (HLTH 1901) form, or equivalent, and complete the Ordering Practitioner, Address and MSP practitioner number box located on the upper right hand side of the form. This information directs the laboratory test results to the appropriate ordering practitioner and work site.
2. If copies to a physician are required, complete the Copy To Physician/MSP Practitioner Number section located on the upper right hand side of the SOPLR form.
3. Complete the Surname of Patient, First Name of Patient, Date of Birth, Sex, and the Personal Health Number (PHN) sections.
4. Refer to the RN(C) Test Ordering Chart to select the appropriate box(es) on the requisition for the test or tests being ordered, or use the Free Text box.
5. Sign and date the form before providing it to the patient.
Note: In order for your patient’s laboratory results to be directed to the appropriate ordering location, a completed RN(C) Practitioner Information Profile (HLTH 1936) (PDF, 580KB) form must first be submitted to your local laboratories, both health authority and private.