•       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:

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:

Item Requested:


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:
Band-aids, cloth, non-latex:
BZK Antiseptic Towelettes:
C&S stool culture preservative:
Clean stool preservative :
Culture Swab, Blue Top Amies:
Green Vacutainer, 4ml (Lithium Heparin):
Green Vacutainer, 4ml (Sodium Heparin):
InSure FIT Kit:
Lab Requisition Forms:
Large Gloves (Non-Latex):
Large Specimen Transport Bag:
Lavender Vacutainer, 4ml (K3-EDTA):
Light Blue Vacutainer, 3ml (Sodium Citrate):
Medium Gloves (Non-Latex):
Misc. Vacutainers: royal blue, grey, etc. please specify which and how many:
Multi-purpose Copy Paper:
Needle Holders/Hubs w/o safety:
Paper Tape:
Parasep SF:
Plain Red Vacutainer, 6ml (serum):
Pour Off Tubes:
Printer Toner (Brother HL-2280DW):
Printer Toner (Brother HL-L2380):
Sharps Container 3gal(large):
Sharps Container 5qt (small):
Small Gloves (Non-Latex):
Small Specimen Transport Bag:
Speculum (small):
Speculum (medium):
Speculum (large):
SST Gel Vacutainer, 8ml (serum separation):
Sterile Cup, 4oz urinalysis:
ThinPrep pap vial:
Urine Culture Kit:
UTM Swab:

Additional Items: