Supplies

Order Supplies

Account Information

Account Name

Client Code

Address

Ordered By

Date

Collection Supplies / (Amt per Unit) / Quantity Needed

Alcohol Prep Pad (200/Box)

Aerobic Culture Swab (50/Bag)

Aptima Multitest Swab-Orange (Individual)

Aptima Unisex Genital Swab-White/Purple (Individual)

Band Aids (100/Box)

Biohazard Sharps Containers - Small

Biohazard Sharps Containers - Large

Biopsy Bottle (20 mL - 32/Box)

Biopsy Bottle (90 mL - 24/Box)

Coflex (Individual Rolls)

Commodes/Stool Hats (Individual)

Cotton Balls (Large Bag)

Glucola 50 G (6/Pack)

Glucola 75 G (6/Pack)

Glucola 100 G (6/Pack)

Gauze - 2x2 (100/Pack)

Gauze - 4x4 (100/Pack)

Gloves - Small (100 Pairs/Box)

Gloves - Medium (100 Pairs/Box)

Gloves - Large (100 Pairs/Box)

Gloves - Extra Large (100 Pairs/Box)

Hemocult Cards (Individual)

OB Towelettes (100/Box)

Ova & Parasite Kits (Individual)

Paper Tape (Individual)

Specimen Bags - Small (50/Pack)

Specimen Bags - Large (Individual)

Thin Prep Pap Kit (25/Tray)

Thin Prep - Brushes & Brooms (25/Pack)

Tourniquets (Individual)

Urine Cups - Sterile (100/Bag)

Urine Cups - Non Sterile (100/Bag)

Urine C&S Transport (Individual)

Urine 24 Hour (Individual)

Viral Transport Media-M4 (Individual)

Tubes / (Amt per Unit) / Quantity Needed

SST - Gold Top (100/Pack)

Lavender Top (100/Pack)

Light Blue Top (100/Pack)

Grey Top (100/Pack)

Light Green Top (Lithium Hep) (Individual)

Dark Blue Top (EDTA) (Individual)

ACD Solution A (Individual)

ACD Solution B (Individual)

Blood Culture SPS (Individual)

Plain Red Top (Individual)

Needles & Holders / (Amt per Unit) / Quantity Needed

21x1¼ Needle w/ Pre-Attached Holder (100/Box)

23g Safety Lock Butterfly (50/Box)

21g Safety Lock Butterfly (50/Box)

Needle Holders (50/Box)

Forms & Requisitions / (Amt per Unit) / Quantity Needed

Lab Blood Reqs (Individual)

Cyto/Path Reqs (Individual)

Toxicology Reqs (Individual)

Chain of Custody Reqs (Individual)

4Medica Paper (250/Pack)

Yellow Result Paper (500/Pack)

Supply Forms (Individual)

Drawn by Biotech STAMP (Individual)

Replacement Ink for STAMP (Individual)

Shipping Supplies / (Amt per Unit) / Quantity Needed

Fedex Shipping Label (Individual)

Fedex Clinical Pak (Individual)

Printer Cartridge Model # or Printer Model:

Printer Cartridge Quantity

Special Orders/Misc

For security purposes, please select the lab's website from the list below

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