Lab Supply Order Form

NAME OF THE PRACTICE CLIENT NUMBER STREET CITY ORDER FILLED OUT BY EMAIL

ACD TUBE

ea

BLUE TOP _____4.5 ML

ea

PINK _____6.0 ML

ea

PURPLE TOP - MOLECULAR TUBE_____6.0 ML

ea

_____DARK BLUE NO ADD

ea

____DK BLUE EDTA

ea

____TAN

ea

LIGHT GREEN LITHIUM HEPARIN_____3.0 ML

ea

DARK GREEN LITHIUM HEPARIN_____4.0 ML

ea

DARK GREEN SODIUM HEPARIN_____6.0 ML

ea

PEARL TOP _____6.0 ML

ea

LAVENDER TOP _____5.0 ML(3.0ML DRAW)

ea

SST

ea

CLEAR DISCARD TUBE

ea

_____GREY TOP

ea

_____RED TOP

ea

ALCOHOL PADS

bx

SAFETY NEEDLES _____21 X 1 1/4

bx

SAFETY NEEDLES _____22 X 1 1/4

48/bx

VACUTAINER HOLDERS

ea

GLUCOLA _____50 GM ORANGE

ea

GLUCOLA _____100 GM ORANGE

ea

_____BANDAIDS

pk

BUTTERFLY NEEDLE 23G 3/4

ea

GAUZE PADS

pk

PLASTIC SERUM TRANS. TUBES (WHITE CAP)

ea

SPECIMEN BAGS

50/pk

TOURNIQUET

ea

PLASTIC BAGS - LARGE

pk

RED STAT SPECIMEN BAGS

50/pk

24 HOUR COLLECTION CONTAINER

ea

ANTISEPTIC TOWELETTES

box

PLASTIC URINE TRANSFER TUBES (YELLOWCAP)

ea

UA PRESERVATIVE TUBES & STRAWS

ea

STERILE URINE CUP

ea

PIPETTES

ea

URINE HATS

ea

URINE CULTURE KITS (WITH C&S PRESERVATIVE)

ea

DISPOSABLE DIP CUPS WITH LIDS

100/slv

AEROBIC CULTURE SWABS (ESWAB FOR WOUND, THROAT, STREP SCREEN)

ea

ANAEROBIC CULTURE SWABS (DEEP WOUND, ABSCESS)

ea

BLOOD CULTURE BOTTLE _____AEROBIC

ea

BLOOD CULTURE BOTTLE _____ANAEROBIC

ea

BLOOD CULTURE BOTTLE _____PED

ea

____VIRAL TRANSPORT MEDIA (VTM)/M6/M4 (VIRAL/ HERPES/ MYCOPLASMA)

ea

____VIRAL TRANSPORT MEDIA (VTM) FOR UREAPLASMA CULTURE

ea

____COBAS PCR CONTAINER FOR GC/CT/TRICH - ENDOCERVICAL (FEMALE ONLY)

ea

____COBAS PCR CONTAINER FOR GC/CT/TRICH - URINE (MALE & FEMALE)

ea

OVA AND PARASITE/AMOEBA COLLECTION KIT

ea

STOOL CULTURE COLLECTION KIT

ea

FLU SWABS

ea

BD MAX UVE KIT - VAGINAL PATHOGENS

ea

IFOB COLLECTION KIT W/ MAILER

ea

IFOB COLLECTION VIAL

ea

BREATHTEK KIT

ea

PERTUSSIS SWAB

ea

FETAL FIBRONECTIN (FFN)

ea

TT BROCHURES

50/pk

BIOPSY CONTAINERS _____40 ML

ea

BIOPSY CONTAINERS _____60 ML

ea

CYTOLOGY SLIDES

box

PAP SMEAR KIT _____1-SLIDE (PREFERRED)

box

PAP SMEAR KIT _____2-SLIDE

box

THIN PREP PAP VIALS INCLUDES SPATULA / BRUSH

25/pk

SLIDE HOLDERS (CARDBOARD MAILERS)

ea

URINE CYTOLOGY COLLECTION JAR (FNA)

ea

AFP (ALPHA FETA-PROTEIN) QUESTIONNAIRE

100/px

CYTOLOGY / HISTOLOGY REQUISITIONS

100/px

DRAWING STATION LOCATIONS / MAP

50/pk

LABORATORY REQUISITIONS

100/pk

LASER REPORT PAPER

box

LAB WORKS PAPER

box

ALLERGEN FORMS

50/pad

TEST ADD-ON FORMS

ea

SUPPLY ORDER FORMS - MAXIMUM 5

ea

ABN FORMS

pk

HEMOCULT SLIDE (DEVELOPER NOT AVAILABLE)

3/pk

HEMOCCULT MAILER

ea

DROP BOX _____LARGE

ea

DROP BOX _____SMALL

ea

HP TONER _____2300D

ea

HP TONER _____2420

ea

HP TONER_____3005

ea

LEXMARK TONER _____6340

ea

LEXMARK TONER _____6350

ea

LEXMARK TONER _____6360

ea

LEXMARK TONER _____8100

ea

LEXMARK TONER _____8200

ea

HP TONER _____HP1320

ea

LEXMARK PHOTOCONDUCTOR_____6340

ea

LEXMARK PHOTOCONDUCTOR_____6350

ea

LEXMARK PHOTOCONDUCTOR_____6360

ea

CRITICAL FROZEN - BLUE SLIPS

ea

MOLECULAR PATH SLIPS - YELLOW

pkg

SHARPS CONTAINER _____RED 8 QT

ea

_____WHITE 3 GAL

ea

DYMO LABELS

ea

Miscellaneous