M 313 OCT 0 1 Z015 ORDER OF THE MINISTER OF HEALTH PROVINCE OF BRITISH COLUMBIA. Class of referring practitioner. Schedule

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1 Ministerial Order No. M 313 PROVINCE OF BRITISH COLUMBIA ORDER OF THE MINISTER OF HEALTH I, Terry Lake, Minister of Health order that: Schedules in respect of the benefits that may be requested by the following classes of referring practitioners are established as set out in the attached schedules, as applicable: Class of referring practitioner The class established under section 3(1)(b) of the Laboratory Services Regulation. The class established under section 3(2) of the Laboratory Services Regulation. The class established under section 3(1)( c) of the Laboratory Services Regulation. Schedule Schedule A - Midwives Laboratory Services Referral Schedule. Schedule B - Registered Nurses (Certified) Laboratory Services Referral Schedule. Schedule C - Podiatrists Laboratory Services Referral Schedule. Date OCT 0 1 Z015 Minister of Health (This part is for administrative purposes only and is not part of the Order.) Authority under which Order is made: Act and section:- Laboratory Services Act, sections 1 and 71 (b) Other (specify):-laboratory Services Regulation, section 3(1), (2) and (3)

2 SCHEDULE A MIDWIVES LABORATORY SERVICES REfERRAL SCHEDULE Midwives may refer beneficiaries for the following prescribed Fee-for-Service outpatient laboratory medicine services (benefits), provided the service falls within the Midwives' scope of practice. Midwives may also refer for medically required non Fee-for-Service insured laboratory medicine tests approved within the Midwives' scope of practice. ALANINE AMINOTRANSFERASE ALBUMIN CREATININE RATIO (ACR) ALBUMIN, SERUM/PLASMA ALKALINE PHOSPHATASE ALPHA FETOPROTEIN ALPHA-THALASSEMIA,MOLECULAR TESTING FOR COM DEFECT ANAEROBIC CULTURE INVESTIGATION ANTIBIOTIC SUSCEPTIBILITY TEST - SEMi-QUANTITATIVE ANTIGLOBULIN COOMBS TEST - DIRECT ASPARTATE AMINOTRANSFERASE BILIRUBIN TOTAL, SERUM/PLASMA BILIRUBIN, DIRECT BiOCHEMICAL IDENTIFICATION - MICRO-ORGANISM BLOOD FILM REVIEW C-REACTIVE PROTEIN CALCIUM TOTAL, SERUM/PLASMA CANDIDA CUL TURE CERVICAL CULTURE CHLAMYDIA TRACHOMATIS USING NAAT - URINE CHLAMYDIA TRACHOMATIS USING NAAT -UROGENITAL SWAB CHLORIDE, SERUM/PLASMA COMBINED VAGI NO-ANORECTAL OR VAGINAL CULTURE COOMBS - INDIRECT CREATININE, RANDOM URINE CREATININE, SERUM/PLASMA CREATININE, TIMED URINE COLLECTION CYTOGENETIC ANAL YSIS - CHORIONIC VILLUS CYTOGENETIC ANAL YSIS - CUL TURED AMNIOTIC FLUID CYTOGENETIC ANAL YSIS - CUL TURED TISSUE CYTOGENETIC ANALYSIS/FLUORESCENCE IN SITU, SINGLE FERRITIN, SERUM 91645

3 FIBRINOGEN, QUANTITATIVE, CHEMICAL FOETAL CELL STAIN FREE T GENITAL CULTURE - OTHER SITE GLUCOSE - 2 HR, POST-7SG GLUCOSE TOLERANCE TEST, 2-5 HOURS GLUCOSE TOLERANCE TEST-GESTATIONAL PROTOCOL GLUCOSE, GESTATIONAL ASSESSMENT GLUCOSE, QUANTITATIVE SERUM/PLASMA GLUTAMYL TRANSPEPTIDASE (GTP) GON"ORRHEA BY NAAT-URINE GONORRHEA BY NAAT-UROGENITAL SWAB HAEMATOLOGY PROFILE HAEMOGLOBIN ONL Y HAEMOGLOBIN, A1C HAEMOGLOBIN-CYANMETHAEMOGLOBIN HEMOGLOBIN ELECTROPHORESIS HEPATITIS B CORE ANTIBODY (ANTI-HBC) HEPATITIS B SURFACE ANTIBODY (ANTI-HBS) HEPATITIS B SURFACE ANTIGEN LACTATE DEHYDROGENASE, SERUM/PLASMA MAGNESIUM, SERUM/PLASMA PHOSPHATES, SERUM/PLASMA PLATELET COUNT ONL Y POTASSIUM, SERUM/PLASMA PREGNANCYTEST-SERUM PREGNANCY TEST, IMMUNOLOGIC - URINE PRIMARY BASE FEE - CHEMISTRY PRIMARY BASE FEE (COLLECTING) - CHEMISTRY PROTEIN TOTAL, SERUM OR PLASMA PROTEIN, TIMED URINE COLLECTION PROTHROMBIN TIME/INR QUANTITATIVE BETA HCG ROUTINE CUL TURE SEROLOGICAL IDENTIFICATION -MICRO-ORGANISM SICKLE CELL IDENTIFICATION SODIUM, SERUM/PLASMA SPLIT BASE FEE (REFERRAL FACILITY) STAINED SMEAR THALASSEMIA/HEMOGLOBINOPATHY INVESTIGATION THROAT OR NOSE CUL TURE THROMBOPLASTIN TEST, PARTIAL THYROID STIMULATING HORMONE, TSH THYROPEROXIDASE ANTIBODIES 92332

4 fee Item Description TRICHOMONAS AND/OR CANDIDA, DIRECT EXAMINATION TRICHOMONAS ANTIGEN TEST UREA, SERUM/PLASMA URETHERAL CULTURE URIC ACID, SERUM/PLASMA URINALYSIS - OR ANY PART OF (SCREENING) URINALYSIS, MACROSCOPIC URINAL YSIS, MICROSCOPIC URINAL YSIS-MICROSCOPIC EXAM OF CENTRIFUGED DEPOSIT URINE COLONY COUNT CULTURE VAGINAL CUl TURE VENEPUNCTURE VITAMIN

5 SCHEDULEB REGISTERED NURSES (CERTIFIED) LABORATORY SERVICES REFERRAL SCHEDULE Registered Nurses (Certified) may refer beneficiaries for the following prescribed Fee-Far-Service outpatient laboratory medicine services (benefits), provided the service falls within the Registered Nurses' (Certified) scope of practice. Registered Nurses (Certified) may also refer for medically required non Fee-for-Service insured laboratory medicine tests approved within the Registered Nurses' (Certified) scope of practice. ANTIBIOTIC SUSCEPTIBILITY TEST - SEMI-QUANTITATIVE PER ORGANISM BIOCHEMICAL IDENTIFICATION OF MICRO-ORGANISM - PER ORGANISM BIOCHEMICAL IDENTIFICATION OF MICRO-ORGANISM IN STOOL CANDIDA CUL TURE CERVICAL CUL TURE CHLAMYDIA TRACHOMATIS USING NAAT - URINE CHLAMYDIA TRACHOMATIS USING NAAT - UROGENITAL SWAB ECG TRACING, WITHOUT INTERPRETATION EXAMINATION FOR PINWORM OVA FIT ANAL YSIS ONL Y GLUCOSE QUANTITATIVE - SERUM/PLASMA GONORRHEA BY NAAT - URINE GONORRHEA BY NAAT - UROGENITAL SWAB HAEMATOLOGY PROFILE HEPATITIS A - IGM (ANTI-HAV-IGM) HEPATITIS B ANTIGEN NOTE: T90675 ONLY TO BE PERFORMED IF HBSAG IS POSITIVE HEPATITIS B CORE ANTIBODY (ANTI-HBC) HEPATITIS B SURFACE ANTIBODY (ANTI-HBS) HEPATITIS B SURFACE ANTIGEN (HBSAG) MACROSCOPIC EXAMINATION OF PARASITE AND/OR DIRECT MICROSCOPIC EXAMINATION PREGNANCY TEST - IMMUNOLOGIC URINE PRIMARY BASE FEE PRIMARY BASE FEE (COLLECTING LABORATORY) PRIMARY BASE FEE (REFERRAL LABORATORY ROUTINE CULTURE SAMPLE COLLECTION ONL Y SEROLOGICAL IDENTIFICATION OF BACTERIAL MICRO ORGANISM STAINED SMEAR 90740

6 STOOL CUL TURE STOOL EXAMINATION, CONCENTRATION METHODS STOOL EXAMINATION, SEARCH FOR AMOEBAE AND/OR PERMANENT STAIN SMEAR STREPTOCOCCI - RAPID TEST THROAT OR NOSE CUL TURE THROAT OR NOSE CUL TURE - EACH ADDITIONAL CUL TURE TRICHOMONASAND/OR CANDIDA, DIRECT EXAMINATION TRICHOMONAS ANTIGEN TEST TROPONIN URETHRAL CUL TURE URINAL YSIS - CHEMICAL OR ANY PART OF URINAL YSIS - COMPLETE DIAGNOSTIC. SEMI-QUANT AND MICRO URINALYSIS - MICROSCOPIC URINALYSIS - MICROSCOPIC EXAMINATION OF A CENTRIFUGED DEPOSIT URINAL YSIS, MACROSCOPIC, TO INCLUDE ANY/ALL OF DIPSTICK, SPECIFIC GRAVITY, VISUAL URINE COLONY COUNT CUL TURE VAGINAL CUL TURE VENEPUNCTURE VIRUS ISOLATION 90830

7 SCHEDULEC PODIATRISTS LABORATORY SERVICES REFERRAL SCHEDULE Podiatrists may refer beneficiaries for the following prescribed Fee-Far-Service outpatient laboratory medicine services (benefits), provided the service falls within the Podiatrists' scope of practice. Podiatrists may also refer for medically required non Fee-for-Service insured laboratory medicine tests approved within the Podiatrists' scope of practice. ACETYLCHOLINE RECEPTOR ANTIBODIES - QUALITATIVE ALANINE AMINOTRANSFERASE ALBUMIN CREATININE RATIO (ACR) ALBUMIN, SERUM/PLASMA ALKALINE PHOSPHATASE ALPHA FETOPROTEIN AMPHETAMINES AMYLASE, SERUM/PLASMA ANAEROBIC CULTURE INVESTIGATION ANTIBIOTIC SUSCEPTIBILITY TEST - SEMI-QUANTITATIVE ANTICARDIOLIPIN AB, IGG ANTICARDIOLIPIN AB, IGM ANTI-DNA ANTIMYELOPEROXIDASE ANTIBODY ANTI-TISSUE TRANSGLUTAMINASE ANTIBODIES(ANTI-TTG) ASPARTATE AMINOTRANSFERASE BENZODIAZEPINES BETA 2 GL YCOPROTEIN I ANTIBODIES IGG/IGM ISOTYPE BICARBONATE, SERUM/PLASMA BILIRUBIN TOTAL, SERUM/PLASMA BILIRUBIN, DIRECT BIOCHEMICAL IDENTIFICATION - MICRO-ORGANISM BIOCHEMICAL IDENTIFICATION - MICRO-ORGANISM/STOOL BK POL VOMA VIRUS IDENT BY NUC ACID AMPLIF, DIRECT BLOOD CUL TURE - AEROBIC/ANAEROBIC MEDIA BLOOD FILM REVIEW B-TYPE NATRIURETIC PEPTIDE(BNP OR NT-PROBNP) C-REACTIVE PROTEIN C. DIFFICILE TOXIN - IMMUNOLOGICAL CA CA CALCIUM TOTAL, SERUM/PLASMA CANDIDA CUL TURE CELL COUNT - CSF AND OTHER BODY FLUIDS 91355

8 CELL DIFFERENTIAL - CSF AND OTHER BODY FLUIDS CHLAMYDIA TRACHOMATIS USING NAAT - URINE CHLORIDE, SERUM/PLASMA CHLORIDE, WHOLE BLOOD CIRCULATING INHIBITOR SCREEN - UNINCUBATED-SIMPLE CLOSTRIDIUM DIFFICILE TOXIN - TISSUE CUL TURE COCAINE/COCAINE METABOLITE CORTISOL CREATINE KINASE CREATININE, RANDOM URINE CREATININE, SERUM/PLASMA CREATININE, TIMED URINE COLLECTION CRYOGLOBULINS CRYSTAL IDENTIFICATION SYNOVIAL FLUID CSF - ALBUMIN CSF - IMMUNOGLOBULIN G CYCLIC CITRULUNATED PEPTIDE ANTIBODIES CYTOLOGIC INTERPRETATION OF PRE-SCREENED CYTOLOGY DILUTE RUSSELL VIPER VENOM TIME ELECTROPHORESIS, C.S.F ENA (EXTRACTABLE NUCLEAR ANTIGENS) FIBRIN/FIBRINOGEN DEGRADATION/INCLUDING 0 - DIMER FIBRINOGEN, QUANTITATIVE, CHEMICAL FINE NEEDLE ASPIRATE - CYTOLOGIC EXAMINATION FOLIC ACID FREE T FUNGUS CUL TURE FUNGUS DIRECT EXAMINATION KOH PREPARATION GENITAL CULTURE - OTHER SITE GLUCOSE QUANTITATIVE, CSF GLUCOSE QUANTITATIVE, TRANSUDATE/EXUDATE GLUCOSE TOLERANCE TEST, 2-5 HOURS GLUCOSE, QUANTITATIVE SERUM/PLASMA GLUTAMYL TRANSPEPTIDASE (GTP) GONORRHEA BY NAAT-URINE HAEMATOLOGY PROFILE HAEMOGLOBIN ONLY HAEMOGLOBIN, A1C HAEMOGlOBIN-CYANMETHAEMOGLOBIN HEUCOBACTER PILORI CARBON 13 UREA BREATH TEST HEPATITIS A - IGM ANTIBODY (ANTI-HAV-IGM) HEPATITIS B CORE ANTIBODY (ANTI-HBC) HEPATITIS B SURFACE ANTIBODY (ANTI-HBS) HEPATITIS B SURFACE ANTIGEN 91765

9 HLA - SINGLE ANTIGEN HLA GENOTYPING IGA QUANTITATIVE, SERUM/PLASMA IGG - QUANTITATIVE SERUM IMMUNOFLUORESCENT STAINING - ADD. AUTOANTIBODIES IMMUNOFLUORESCENT STAINING - FIRST AUTOANTIBODY INSULIN, FIRST SPECIMEN KETO ACIDS CHROMATOGRAPHY - SCREENING TESTS - URIN LACTATE DEHYDROGENASE, SERUM/PLASMA LACTATE DEHYDROGENASE, TRANSUDATE/EXUDATE LACTATE, WHOLE BLOOD LATEX TEST (RHEUMATOID FACTOR) LIPASE MAGNESIUM, SERUM/PLASMA METHADONE METABOLITE OCCUL T BLOOD-FECES OPIATES PH, PC02 AND P PHOSPHATES, SERUM/PLASMA PHOSPHOLIPID NEUTRALIZATION TEST - CONFIRM LUPUS PLASMA HAEMOGLOBIN POTASSIUM, SERUM/PLASMA POTASSIUM, WHOLE BLOOD PRE ALBUMIN PREGNANCYTEST-SERUM PREGNANCY TEST, IMMUNOLOGIC - URINE PRIMARY BASE FEE - CHEMISTRY PRIMARY BASE FEE - DRUGS OF ABUSE PRIMARY BASE FEE (COLLECTING) - CHEMISTRY PROLACTIN PROTEIN TOTAL, SERUM OR PLASMA PROTEIN TOTAL, TRANSUDATE/EXUDATE PROTEINASE 3 ANTINEUTROPHIL CYTOPLASMIC ANTIBODY PROTEINS, TOTAL QUANTITATIVE, C.S.F PROTHROMBIN TIME/INR QUANTITATIVE BETA HCG ROUTINE CULTURE SEDIMENTATION RATE SEROLOGICAL IDENTIFICATION -MICRO-ORGANISM SEROLOGICAL TESTS ANTIGENS SEROLOGICAL TESTS - > 4 ANTIGENS SLIDE AGGLUTINATION - INFECTIOUS MONONUCLEOSIS SODIUM, SERUM/PLASMA SODIUM, WHOLE BLOOD 92233

10 SPLIT BASE FEE (REFERRAL FACILITY) STAINED SMEAR STOOL CUL TURE STOOL EXAMINATION -AMOEBAE T3-FREE TESTOSTERONE FREE TESTOSTERONE TOTAL THROMBOPLASTIN TEST, PARTIAL THYROID STIMULATING HORMONE, TSH TRANSFERRIN TROPONIN UREA, SERUM/PLASMA URIC ACID, SERUM/PLASMA URIC ACID, SYNOVIAL FLUID URIC ACID, TIMED URINE COLLECTION URINAL YSIS - OR ANY PART OF (SCREENING) URINALYSIS, MACROSCOPIC URINAL YSIS, MICROSCOPIC URINAL YSIS, SCREENING AND MICROSCOPIC URINAL YSIS-MICROSCOPIC EXAM OF CENTRIFUGED DEPOSIT URINE COLONY COUNT CUL TURE VALPROIC ACID VANCOMYCIN VENEPUNCTURE VIRUS ISOLATION VITAMIN B WHITE CELL COUNT ONl Y 90570