A referral is a written request from a physician or nurse practitioner to a specialist. A specialist's office will normally not open its schedule without one, because OHIP only pays a specialist for a consultation when the written request came first. A requisition is the same idea for a test: the lab needs an order from a clinical provider such as a physician, midwife or nurse practitioner.
What the visit covers
- A referral to whichever specialist the problem needs — cardiology, dermatology, orthopaedics, psychiatry and surgery among them
- Requisitions for blood and urine tests at a community lab
- Requests for X-ray, ultrasound, CT or MRI
- A repeat requisition for a test that has to be done again on a schedule
- A lost requisition — ask the desk what it takes to replace one
- A visit to read a specialist's letter or a result and decide what happens next
How a referral has to work
A referral has to be a written request from a physician or nurse practitioner who has professional knowledge of you. It names the consultation being asked for, names the referring provider with their billing number, carries your name and health number, and sets out what is relevant and what service is wanted. Without a written request, OHIP pays the specialist for an assessment rather than a consultation.
It cannot be arranged backwards. The Ministry's billing guidance is explicit that a written request must precede the consultation and may not be provided retroactively. Booking yourself in with a specialist and asking for the request afterwards does not work.
The specialist owes a written report back to the referring provider, with findings, opinions and recommendations. The recommendations in it are for your own doctor to act on — a medication change, another test, a date to check again.
What OHIP covers
A medically necessary visit is insured, and that includes the visit where a referral or a requisition gets written. Medically necessary lab tests taken outside hospital, at a community lab, are covered once a clinical provider has ordered them. Not every box on the lab form is insured, though. PSA is covered where prostate cancer is suspected or is being monitored after diagnosis. Vitamin D is covered where there is a reason for it — osteoporosis, rickets, osteopenia, malabsorption, renal disease, or drugs that affect how you handle vitamin D. Outside those, you pay for the test yourself, so ask which box is being ticked and what it costs before you leave with the form.
Walk in, or book?
The examination comes first, either way. A specialist is being asked for an opinion on something a doctor has looked at, and the Ministry's billing guidance requires the written request to come from a physician or nurse practitioner who has professional knowledge of you. Ask the desk whether a referral can be handled at a walk-in visit or needs a booked one. If your symptoms get worse while you are waiting for the appointment, that is a reason to be seen again rather than to keep waiting.
What to bring
- Your health card
- Whatever prompted this — a letter, a report, an emergency department discharge sheet, or the name of the hospital holding your scans
- Your current medication list
- A phone number that reaches you, with voicemail set up — whoever books the appointment will call you
- Any test results from another province or country, on paper if you have them
Questions people ask
Can I see the specialist first and get the referral written afterwards?
No — not in a way that counts. The Ministry's billing guidance says written requests for consultation must precede the consultation and may not be provided retroactively. A request written after the visit does not turn it into a consultation, and it cannot be backdated. Be examined first and let the request go out before the specialist's office books you.
The wait is months. Is there anything I can do?
Some things. Ontario publishes the average wait by hospital for specialist appointments and for surgery, so you can see where the queue is shorter before you talk to the doctor. The province's own advice is to say you are willing to travel to a specialist with a shorter wait, ask about treatment at a different hospital, take a diagnostic imaging appointment in the evening, at night or on a weekend, and see whether there is a cancellation list you could be added to. Doctors give each patient a priority level from 1 to 4 so the most urgent are cared for first.
Can I find out where the wait is shortest for an MRI or CT?
Yes. Ontario Health reports CT and MRI wait times by location: pick diagnostic imaging, choose adult or paediatric, search by city or postal code, then choose CT or MRI to compare the facilities near you.
Can I ask to be referred to someone else instead?
It is a conversation, not a form you can request. Where you ask for another consultation with a different physician of the same specialty for the same condition, the referring provider has to decide whether it is medically necessary; if it is not, the Ministry's guidance says that service is uninsured. Bring the reason — a symptom that has changed, a question the first opinion left open.
Can I look at my own lab results?
Yes. My Health Record is a secure provincial portal showing your lab results and your publicly funded medication and pharmacy history, and there is no fee to use it. You need to be at least 16, have an unexpired photo Ontario health card, a My Ontario Account for Health, and a smartphone with a working camera for the identity check. If you would rather not use it, Ontario Health takes requests for a printed copy of your health record.
Still have a question? Call the front desk.
Related
- Physicals and what Ontario screens forAnnual check-ups and screening by age
- Chronic care for diabetes, blood pressure and asthmaDiabetes, blood pressure, asthma, heart
- Prescription renewalsBring the bottle or a photo of the label
