Annual bloodwork / wellness panel (executive health screen)

ND-recommended test reviewed: annual bloodwork / wellness panel.
Indications reviewed: no specific risk factor, symptom, or examination finding identified for the bundle as ordered.
Not ordered as a bundle. Rationale discussed: routine annual screening blood tests are not indicated without a risk-based reason; testing many analytes at once increases incidental abnormal results without benefit. Ref: Choosing Wisely Canada Family Medicine.
Patient informed test available privately via ND. Patient given info page: https://labs.ajaxharwoodclinic.com/wellness-panel/patient
Revisit if: new symptoms develop, or a cardiovascular, diabetes, or kidney risk factor is identified.

Indicated when

• —As a label for a set of separately, risk-based indicated components ordered together in an adult who actually has the relevant risk factors: a lipid panel from age 40 or earlier with risk conditions [11], HbA1c or fasting glucose when a risk calculator or risk factors indicate it [12], once-in-a-lifetime Lp(a), creatinine/ACR in diabetes or hypertension, or ALT in the presence of metabolic risk factors [3, 4, 5, 6, 7]. Each component's own indications are detailed in its own record.

Not indicated when

• —Ordering every test in this bundle as an undifferentiated annual or 'executive' panel in an asymptomatic adult with no risk factors, symptoms, or examination findings pointing to a specific concern [1]
• —Repeating the same broad bundle every year regardless of whether the interval is backed by evidence for each component [2]

Why not

Testing many analytes at once increases the statistical chance that at least one will fall outside its reference range by chance alone, in a person with no disease. In an asymptomatic, low-risk adult this generates incidental, usually clinically insignificant abnormalities that prompt repeat testing, further investigation, or specialist referral, at a cost in money, time, and anxiety, without an established benefit to routine annual testing in this group [1].

Better first step

Decide what to test based on the patient's actual risk factors and symptoms, not the calendar: a lipid panel for cardiovascular risk (from an age or risk threshold set by the CCS 2021 guideline), HbA1c or fasting glucose based on diabetes risk factors (Diabetes Canada 2018), a once-in-a-lifetime Lp(a), and creatinine, ALT, or other components only where a specific risk factor or symptom applies. See the individual component records for their own criteria.

Typical ND rationale

An ND may order a broad annual or 'executive' panel bundling many analytes in one visit, reasoning that casting a wide net catches problems early, before symptoms appear, and that patients value having a comprehensive baseline even without a specific complaint.

Ontario coverage & CONO orderability

OHIP status

unverified

'Wellness panel' or 'annual bloodwork' is not itself a line item in the 2026 Schedule of Benefits for Laboratory Services; it is a bundle whose individual components are billed, and covered, separately (see cbc, electrolytes, Liver panel (ALT, AST, GGT, ALP, bilirubin, albumin), Kidney function (creatinine/eGFR, BUN, urine albumin-to-creatinine ratio), HbA1c and fasting glucose (diabetes screening), Lipid panel (total cholesterol, HDL, LDL, triglycerides), and Uric acid (urate) records for each component's own status). Because the bundle itself is not a Schedule listing and its components' coverage differs, overall status for the umbrella label is recorded as unverified. ND-ordered testing is patient-paid regardless of which components are chosen (Reg. 552 s.22(1); SOB-LS 2026 preamble).

CONO orderable

Yes

Not a bundled CONO product; each component analyte is separately on the CONO list under its own item number. See the individual component records for their CONO numbers.

Linked conditions

• tired ↗
• Insulin resistance ↗
• dyslipidemia ↗
• diabetes ↗

Counselling script

“Rather than ordering every test in a standard annual panel, I'd rather base what we check on your actual risk factors and symptoms, since testing everything at once tends to turn up small, meaningless abnormalities that create more worry than benefit. If you have risk factors like high blood pressure, diabetes, or a family history of early heart disease, there are specific tests worth doing on a schedule, and I'm happy to go through which ones apply to you. If nothing like that applies today, I don't think a full annual panel adds value, but I'll order any individual test that becomes relevant as your history changes.”

Revisit if

• —New symptoms suggestive of a specific organ system problem develop
• —A new cardiovascular, diabetes, or kidney disease risk factor is identified
• —A medication is started that requires monitoring

References

1. [1]College of Family Physicians of Canada / Choosing Wisely Canada (2026). Family Medicine: Fifteen Tests and Treatments to Question. linkDon't do annual screening blood tests unless directly indicated by the patient's risk profile
2. [2]Canadian Society for Medical Laboratory Science / Choosing Wisely Canada (2025). Medical Laboratory Science: Fourteen Tests and Treatments to Question. linkDon't support repeat test ordering at a frequency not backed by evidence
3. [3]Canadian Cardiovascular Society (2021). 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. linkFor patients with triglycerides above 1.5 mmol/L, ApoB or non-HDL-C is the preferred lipid parameter for screening
4. [4]Canadian Cardiovascular Society (2021). 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. linkLipoprotein(a) is recommended once in a patient's lifetime as part of initial lipid screening
5. [5]Diabetes Canada (2018). Diabetes Canada Clinical Practice Guidelines: Screening for Diabetes in Adults. linkScreen for type 2 diabetes using fasting plasma glucose and/or A1C every 3 years in adults with risk factors
6. [6]Kidney Disease: Improving Global Outcomes (KDIGO) (2024). Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. linkThe KDIGO 2024 guideline covers risk-based evaluation and risk assessment of people with, or at risk for, chronic kidney disease
7. [7]Ajmera et al., Hepatology (validation cohort describing the AGA/AASLD NAFLD clinical pathway) (2024). Validation of AGA clinical care pathway and AASLD practice guidance for nonalcoholic fatty liver disease in a prospective cohort of patients with type 2 diabetes. linkAGA and AASLD have developed clinical pathways to evaluate populations at high risk for NAFLD, such as patients with type 2 diabetes
8. [8]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkCommunity lab tests are insured only when ordered under the Schedule by an authorized prescriber
9. [9]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
10. [10]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services
11. [11]Canadian Cardiovascular Society (2021). 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. linkLipid screening from age 40 or earlier with risk conditions
12. [12]Canadian Task Force on Preventive Health Care (2012). Recommendations on screening for type 2 diabetes in adults. linkolder guidelineNo routine diabetes screening at low risk; risk-calculator-based screening at high risk