Failure to fill out the lab requisition properly could result in rejection of the sample, or cause a delay in test result reporting. Leaking specimens will not be processed!
Section 1
- Physician: Dr. Mehdi Aloosh
- Phone: 519-258-2146
- Fax: 226-783-2132
- The name of the family or facility’s doctor can be entered here as well, and they will also receive a copy of the results.
- Agency: Windsor-Essex County Health Unit
1005 Ouellette Avenue, Windsor, ON N9A 4J8
Section 2
Must be completely filled out.
If the patient is from a Long-Term Care Home, please write the name of the home in this section. Remember to include the outbreak number for this outbreak (if known).
Section 3
Tests Required
Enteric – stool specimens
Respiratory – nasopharyngeal specimens: Influenza A, B (Flu) Virus Detection
Direct test for Influenza and RSV if suspected. Direct test will apply to the first few specimens only in an influenza outbreak.
Unless otherwise ordered by the Windsor-Essex County Health Unit:
All samples must be transported to the Public Health Lab in London, Ontario in approved packaging by calling the Health Trans Courier 519-791-0515 after 8 a.m.
Examples of approved packaging: a soft-sided cooler bag, or a box that is sealed and labelled, SPECIMENS.
Section 4
All applicable boxes must be filled in.
Comments:
Attention: Outbreak Team.