CP Supply Order Form » Pathology Laboratories » College of Medicine

Name(Required)

First Last

Date(Required)

Phone(Required)

Location:(Required)

Street Address Address Line 2 City State ZIP Code

Collection Blood

Tourniquest Latex Flat (250 Each)

Needle Holder Disposable (1000 Each)

Needle Eclipse, Green, 21G (48 Each)

Needle Eclipse, Black, 22G (48 Each)

Butterflies Safety-Lok 21G (100 Each)

Butterflies Safety-Lok 23G (100 Each)

Butterflies Safety-Lok 25G (100 Each)

McKesson Bandages 1" X 3" (100 Each)

Transfer Tubes (100 Each)

Vacutainer Luer Adapter (100 Each)

Lancets BD Microteiner (100 Each)

Vacutainer Needle Holders - Hubs (100 Each)

Collection Blood Tubes

Tiger Top SST Tubes 8.5ml (100 Each)

Gold Top SST Blood Collection 5ml (100 Each)

Gold Top SST Blood Collection 4ml (100 Each)

Tan Top K2 EDTA (K2E) 5.4mg Blood Collection 3ml (100 Each)

Grey Top Blood Sodium Fluoride Potassium Oxalate 4ml (100 Each)

Grey Top Blood Sodium Fluoride Potassium Oxalate 2ml (100 Each)

Red Top Blood Collection 5ml (100 Each)

Red Top Blood Collection 10ml (100 Each)

Clear & Red Top No Additive (Z) 6ml (100 Each)

PST Gel & Lithium Hep Light Green (Mint) Top 3ml (100 Each)

Dark Green Blood Collect Lithium Heparin 6ml (100 Each)

Dark Green Blood Collect Sodium Heparin (NH) 6ml (100 Each)

Dark Royal Blue Top Trace Element Serum 6ml (100 Each)

Dark Royal Blue Top Trace Element K2 EDTA 6ml (100 Each)

KS Medical Lavender Tops K2 EDTA 5ml (100 Each)

Light Blue Top Blood Collection Buffered Sodium Citrate (9 NC) 2.7ml (100 Each)

Specimen Transport

Specimen Routine Bag (200 Each)

Specimen STAT Bag (200 Each)

Specimen Bags X-Large (100 Each)

Frozen Specimen Bag (100 Each)

Pippettes (100 Each)

Sterile Container 90ml Green Lid (400 Each)

Vial transfer Blue Cap (1000 Each)

Plastic Transfer Vial 5ml (1000 Each)

Vial transfer Amber Light Protected (2000 Each)

Red Flange Cap (1000 Each)

Collection Urine

24HR Urine Container w/ Boric Acid (1 Each)

24HR Urine Container w/ HCL (1 Each)

24HR Urine Container Plain (1 Each)

Urine Collection Kit (Grey top, Tiger top, Sterile Cup 90 ml) (50 Each)

Urine Collection Cup 90 ml (50 Each)

Collection Stool

iFOBT Mailer (1 Each)

Stool Culture (C&S) (1 Each)

Stool Clean Vial (1 Each)

O & P (ZnPVA) (1 Each)

Fecal Fat Container (1 Each)

Collection Microbiology

Culture Swab (White Cap) (1 Each)

UTM Viral Swab (Purple Cap) (1 Each)

Aptima Urine Kit (Ct/Ng) (1 Each)

Orange Aptima Multitest Swab (1 Each)

Aptima Unisex Kit (Ct-Conjunctival) (1 Each)

Miscellaneous Supplies

GTT Beverage 75 GM (6 Each)

GTT Beverage 50 GM (6 Each)

Collection Cytology / Histology

Formalin 30ml Prefilled Container (1 Each)

Formalin 40ml Prefilled Container (1 Each)

Formalin 60ml Prefilled Container (1 Each)

Formalin 120ml Prefilled Container (1 Each)

Thinprep Vial (50 Each)

Kit Urine Cytology (20 Each)

Collection Cytology Solution (4 Each)

Other:

Please list any other supplies and their quantities.