Order Supplies

Account Information:

Account Name:
Client Code:
Address:
Ordered by:
Date:

Product Information:

Item

Qty

Notes

Aerobic Culture Swab

Alcohol Prep Pad

Bag - Specimen Large - (Courier Bag)

Bag - Specimen Small

Band-aids

Biohazard Sharps Containers

Biopsy Bottle 20 ml

Biopsy Bottle 90 ml

Blood Culture SPS tubes

Cotton Balls

Genprobe Collection Kit

Glucola 100 G

Glucola 75 G

Glucola 50 G

Hemocult Cards

HPV DNA Collection Device

Iodine Prep Pad

Gloves --- Latex Free

Size

Needle w/Attached Holder 21 x 1 1/4 G

Needle Butterfly 21 G Safety lock

Needle Butterfly 23 G Safety lock

OB Towlettes

Needle Holder

Ova & Parasite Kit

Paper Tape

Sponge 2 x 2

Sponge 4 x 4

Stool / Urine Hats

Sure Path

Thin Preps

Tourniquet --- Latex Free

Trichomonas Broth

Urine - 24 hr. Container:
Plain HCL Boric Acid

Urine C & S Transport

Urine Cups - Non-Sterile

Urine Cups - Sterile

Vacutainer - ACD Solution A or B

Vacutainer - Dk. Blue(EDTA)

Vacutainer - Dk. Blue(No Addit.)

Vacutainer - Grey 5 ml

Vacutainer - Green 7 ml (Sodium Hep)

Vacutainer - Lt. Blue 4-5 ml

Vacutainer - SST

Vacutainer - Lavender 5 ml

Vacutainer - Red 10 ml

Requisition Forms

4medica Paper (labels)

Blood Request (RX) Forms

Cytology / Pathology Request Forms

Supply Request Forms

Toxicology Forms

White Copy Paper

Yellow Printer Result Paper

Miscellaneous

Printer Cartridge

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