In Ontario, all OHIP-covered diagnostic imaging and cardiology services require a signed requisition from a licensed healthcare provider before any test can proceed. The form communicates the test being requested, the clinical reason for it, and the patient’s identifying information to the imaging or cardiology facility. Without a complete and signed requisition, the appointment cannot be booked and OHIP coverage cannot be applied.
What Is an Imaging Requisition Form
An imaging requisition form is a standardized document completed and signed by a physician, nurse practitioner, or other licensed healthcare provider in Ontario to authorize a specific diagnostic test for a patient. It serves as the formal order that triggers the booking process at an accredited imaging or cardiology facility. The Well Diagnostics requisition forms page provides region-specific downloadable requisitions for all services offered across Ontario and Alberta locations, including radiology, cardiology, and respirology.
Requisitions are distinct from referral letters, though the two are sometimes used together. A referral letter provides clinical context and history. A requisition is the formal order that a facility acts on to schedule and perform the test. Both may be sent together for complex cases, but the requisition is the document that the facility requires at minimum to proceed.
Imaging Requisition Form Requirements
A complete imaging requisition must contain specific information for the test to be booked and for OHIP to cover the service. No diagnostic imaging exam will be performed without a fully completed requisition signed by a licensed physician or nurse practitioner, and any requisition appearing fraudulent will be investigated immediately, with imaging services withheld. The requirements below apply broadly across Ontario diagnostic imaging facilities.
Patient Information
The requisition must include the patient’s full legal name, date of birth, health card number, and contact telephone number. Some facilities also request the patient’s email address and consent to leave voicemail, particularly for booking confirmation. Incomplete patient demographics prevent OHIP verification and may require the patient to be contacted before scheduling can proceed.
Referring Provider Information
The referring physician or nurse practitioner’s full name, CPSO or CNO registration number, clinic name, clinic address, and clinic telephone and fax numbers are all required. The form must also carry the provider’s original signature, not a stamp or digital proxy unless the facility explicitly accepts that format. The provider’s billing number is required in some facilities, particularly for OHIP-covered cardiology services.
Test Requested and Clinical Indication
The specific test being ordered must be clearly identified on the requisition, for example, abdominal ultrasound, echocardiogram, or 24-hour Holter monitor. A clinical indication or reason for the request must also be included. Facilities use this information to assign an appropriate priority level to the appointment and to ensure the radiologist or cardiologist has the clinical context needed to interpret the results accurately. A missing or vague indication is one of the most common causes of requisition-related delays.
Priority Designation
For tests requiring prioritization, particularly CT and MRI at hospitals, and urgent cardiology investigations, the priority level assigned by the referring provider is recorded on the requisition. The Ontario government’s diagnostic imaging wait times information explains that for non-emergency cases, the hospital or imaging centre assigns a priority level of 1 to 4 based on the clinical information in the referral. An accurate and specific clinical indication supports correct priority assignment, which directly affects how quickly the appointment is scheduled.
Information Required on Requisition Forms
The following information is required across imaging and cardiology requisition forms in Ontario.
- Patient full name and date of birth: Required for OHIP verification and scheduling confirmation.
- Health card number: Required at every OHIP-covered appointment, cannot be substituted.
- Patient contact number: Used by the clinic to communicate appointment details and preparation instructions.
- Referring provider name and credentials: Full name and CPSO or CNO number identifying the ordering provider.
- Clinic contact details: Facility name, address, and fax number so the completed report can be transmitted back.
- Specific test requested: The exact imaging or cardiology study being ordered, not a general category.
- Clinical indication: The reason for the test, symptoms, differential diagnosis, or follow-up context.
- Original provider signature: Unsigned or stamped requisitions are not accepted at most Ontario facilities.
- Date of requisition: Facilitates scheduling prioritization and tracks when the order was placed.
Differences Between Imaging and Cardiology Forms
Imaging and cardiology requisitions share the same core patient and provider fields, but differ in the clinical detail they require and the tests they accommodate.
Imaging Requisition Forms
Radiology and diagnostic imaging requisitions cover a wide range of test types on a single form, ultrasound, X-ray, mammography, bone density, and in some facilities MRI and CT. The referring provider selects the applicable test from a checklist or writes it in, along with the relevant clinical indication. For obstetric ultrasound, additional fields for gestational age and specific clinical question are typically included. Well Diagnostics provides separate regional requisitions for radiology and cardiology services, downloadable directly from the requisitions page.
Cardiology Requisition Forms
Cardiology requisitions cover ECG, echocardiogram, Holter monitor, exercise stress test, nuclear stress test, and in some facilities advanced cardiac imaging. They require additional clinical fields not present on standard imaging forms, including indication from a cardiac symptom list, chest pain, dyspnea, palpitations, arrhythmia, syncope, and relevant cardiac history such as prior myocardial infarction, valve disease, or history of heart failure. For nuclear cardiology and stress echocardiography, the specific test protocol must also be identified. Some cardiology forms require the patient’s height and weight and ask about implanted devices such as pacemakers or defibrillators.
How Requisitions Support Booking and Testing
Once a complete requisition is received by the imaging or cardiology facility, the booking process begins. The facility verifies the patient’s OHIP eligibility, reviews the clinical indication to assign a priority level, and contacts the patient with an appointment time and preparation instructions.
For patients, the easiest way to support the booking process is to confirm that their referring provider has either handed them a signed requisition or transmitted it directly to the facility by fax or electronic transfer. Patients can also contact the imaging clinic after the appointment is made to confirm the requisition has been received.
Common Errors and Delays
The following issues account for the majority of requisition-related delays at Ontario imaging and cardiology facilities.
- Missing signature: The most common reason a requisition is rejected, the form must carry an original signature from the ordering provider.
- No clinical indication: A blank or vague indication field prevents priority assignment and may require the facility to contact the referring provider before booking.
- Expired health card: Booking cannot confirm OHIP coverage without a current valid health card number.
- Wrong test specified: Selecting the wrong test category means the facility books equipment and preparation instructions for the incorrect procedure.
- Illegible provider details: If the referring provider’s contact information cannot be read, the completed report cannot be transmitted back to them.
- Incomplete patient contact details: Missing telephone number prevents the facility from confirming the appointment or advising on preparation.
Key Takeaways
- Signature is non-negotiable: No Ontario diagnostic facility will perform an OHIP-covered test without an original provider signature on the requisition.
- Clinical indication affects priority: Facilities assign appointment priority based on the clinical reason provided, vague indications cause delays.
- Imaging and cardiology forms differ: Cardiology requisitions require cardiac-specific fields including symptom category, cardiac history, and device information.
- Well Diagnostics requisitions are region-specific: Download the correct regional form from the Well Diagnostics requisitions page before attending your appointment.
- Electronic transmission is accepted: Physicians can fax or digitally transmit requisitions directly to the facility, patients do not always need a physical copy.
Frequently Asked Questions
Can a patient pick up a requisition form and bring it to the clinic themselves?
Yes. In most cases, a patient can carry the signed requisition directly to the imaging clinic. Some referring providers also fax or electronically transmit the requisition directly to the facility. If your physician has already sent it ahead, confirm with the clinic at the time of booking that it was received.
What happens if my requisition is missing information?
If the requisition is incomplete, missing a signature, clinical indication, or patient health card number, the facility will contact the referring provider to obtain the missing information before booking. This adds time to the scheduling process and may delay your appointment. Confirming with your physician that the form is fully completed before you leave the office prevents this situation.
Do Well Diagnostics cardiology and imaging requisitions differ by region?
Yes. Well Diagnostics provides region-specific requisition forms to ensure the correct facility information, test categories, and fax routing details are included for each location. The requisitions page on the Well Diagnostics website organizes forms by region and service type. Using the correct regional form prevents routing errors and ensures the completed report reaches your referring provider promptly.
Requisition Forms as the Starting Point for Every Test
The imaging or cardiology requisition is the first clinical document in the diagnostic testing process. A complete, signed, and accurately completed requisition shortens the time from referral to appointment, supports correct priority assignment, and ensures the radiologist or cardiologist has the clinical context to produce a useful report. If you are unsure about the status of your requisition, contact your referring provider or the imaging facility directly to confirm it has been received and is complete.
Where to Submit Your Completed Requisition Form
WELL Health Diagnostic Centres operates more than 50 accredited locations across Ontario and Alberta, each accepting completed requisitions for the specific services they offer. Downloading the correct regional requisition form from welldiagnostics.ca/requisitions before your appointment ensures the right facility details, fax routing, and test categories are pre-populated on the form. Locations are organized below by service type to help referring providers and patients identify the nearest clinic for each test category.
