•       ICD Conversion  Tests/Profiles

Online Supply Order

Requester Information:

NAME plus EMAIL or PHONE fields are REQUIRED.
If a receipt or copy of this order is required, check this box
Your Name:
Phone Number:
Email:

Location Information:

ALL fields other than Address Line 2 are REQUIRED.
Location Name:
Location Address Line 1:
Location Address Line 2:
Location City:
Location State:
Location Zip:

Lab/Testing Supplies:

Quantity:

2x2 gauze pads:
21G Needle, multi-draw with safety:
21G Needle, butterfly:
22G Needle, multi-draw with safety:
23G Needle, butterfly:
24 hr urine container:
Alcohol Prep Pads:
Amber Tubes:
Aptima Unisex (purple):
Aptima Urine (yellow):
Band-aids, cloth, non-latex:
BD Affirm:
Biopsy Containers 10ml:
Biopsy Containers 30ml:
Brooms (for pap use only):
Brushes (for pap use only):
BZK Antiseptic Towelettes:
C&S stool culture preservative:
Clean stool preservative :
Coban :
Culture Swab, Blue Top Amies:
Glucola 50 gram (orange only):
Glucola 75 gram (orange only):
Glucola 100 gram (orange only):
Gray Sodium Fluoride Potassium Oxilate:
Green Vacutainer, 4ml (Lithium Heparin):
Green Vacutainer, 4ml (Sodium Heparin):
BBL Culture Swab (Group B Swab):
InSure FIT Kit:
Lab Requisition Forms:
Labels
Large Gloves (Non-Latex):
Large Specimen Transport Bag:
Lavender Vacutainer, 4ml (K3-EDTA):
Light Blue Vacutainer, 3ml (Sodium Citrate):
Medium Gloves (Non-Latex):
Needle Holders/Hubs w/o safety:
Orange Swabs:
Paper Tape:
Parasep SF:
Pipettes:
Plain Red Vacutainer, 6ml (serum):
Pour Off Tubes:
Quantiferon:
Royal Blue EDTA:
Royal Blue Serum:
Sharps Container 3gal(large):
Sharps Container 5qt (small):
Small Gloves (Non-Latex):
Small Specimen Transport Bag:
Spatulas (for pap use only):
Speculum (small):
Speculum (medium):
Speculum (large):
SST Gel Vacutainer, 8ml (serum separation):
Sterile Cup, 4oz urinalysis:
ThinPrep pap vial:
Tourniquets:
Trace Element Transport Tubes (blue cap):
UA Preservative:
Urine Culture Kit:
Urine Transport Straw:
UTM Swab:
Welch Allen Pap (small):
Welch Allen Pap (medium):
Welch Allen Pap (large):

Paper Products:

Quantity:

Multi-purpose Copy Paper:

Printer Supplies:

Quantity:

DCP-7065DN/TN450 (toner):
DCP-7065DN/DR420 (drum):
HL-2280DW/TN450 (toner):
HL-2280DW/DR420 (drum):
HL-L2380DW/TN660 (toner):
HL-L2380DW/DR630 (drum):
DCP-L2540DW/TN660 (toner):
DCP-L2540DW/DR630 (drum):
HL-3170DW/TN221C (toner):
HL-3170DW/TN221M (toner):
HL-3170DW/TN221Y (toner):
HL-3170DW/TN221BK (toner):
HL-3170DW/DR310CL (drum):

Additional Items:


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