Supply Order Form

Forms

Test Requisition

Supply Request

Tubes

Lavender top (4.0ml, K2, EDTA, tray of 100)

Lavender top (9ml, K2, EDTA, each)

Dark Blue top (6ml, K2, EDTA, each)

Dark Blue top (6ml Trace Element Serum, each)

Yellow top (6ml ACD A Solu., each)

Yellow top (6ml ACD B Solu., each)

Red top (10ml, no additive, each)

Red top (6.0ml, no additive, each)

Green top (6ml Sodium Heparin, each)

Gray top (4.0ml Sodium Fluoride, each)

Serum Separator Tube (SST, 8.5ml, tray of 100)

Serum Separator Tube (SST, 4.0ml, tray of 100)

Light Blue top (4.5ml, Buffered Sodium Citrate,

tray of 100)

Microbiology/Virology/Media

Aerobic Blood Culture Bottle (each)

Anaerobic Blood Culture Bottle (each)

M4 Viral Media Tube (each)

Urine Collection

24 Hour Urine (each)

Urine Culture (each)

Urinalysis Tube (Blue top, pack of 10)

Sterile Urine Container (Orange top)

Stool Collection

Occult Blood Stool Card (each)

Ova and Parasite Kits (each)

Parapack C&S (each)

Cytology

Thin Prep (tray of 25)

Cytology Brushes (each)

Cytology Brooms (each)

Pap- Packs (each)

Pathology

10ml Biopsy Container (each)

30ml Biopsy Container (each)

60ml Biopsy Container (each)

Needles

21G x 1"

21G x 1 ½"

22G x 1"

22G x 1 ½"

21G Butterfly

23G Butterfly

Needle Holder (single use)

Needle Holder (multi use)

Miscellaneous

Specimen Bags

Tourniquet Latex (white)

Tourniquet Latex-Free (blue)

Glucose Beverage (50)

Gloves

Alcohol Swabs (box of 200)

Gauze (2x2, sleeve of 200)

Band-Aids (box of 200)

Sharps Container (2 gal, each)

Other

Your Information