Full Name (Enter Client's Name)

Client ID

Email

Phone Number

Address

Facility City

Zip Code

Ordered By

Date

PHLEBOTOMY

SST (25/bag)

Plain Red 8.5 mL (10/bag)

Lavender 4.0 mL(25/bag)

Light Blue 4.5 mL (10/bag)

NMR LIPO Tubes (Blk) (10/bag)

Royal Blue EDTA (10/bag)

Royal Blue Serum (10/bag)

Yellow ACD 8.5 mL (10/bag)

Green Sodium Heparin 10 mL (10/bag)

Green Lithium Heparin 10 mL (10/bag)

21G Safety Butterfly (Green) Needles (10/bag)

23g Safety Butterfly (Light Blue) Needles (10/bag)

GreyTop Sodium Fluoride Potassium Oxalate 10mg/8mg (10/bag)

Requisitions

Blood Requisition Form(50/pack)

Toxicology Requisition Form(50/pack)

RPP Requisiton Form(50/pack)

SPECIMEN BAGS

Transport Bag 6x9 w/Pad(100/bag)

Transport Bag 12x15 500/c (100/bag)

MISCELLANEOUS

Blue Bags (Rolls)

Copy Paper(pack)

Toner For Brother Printer

Breath Test Kit

Specimen Log Book

Cash Log Book

Receipt Book

Frozen Transfer Kit

Sharps Container

2x2 Gauze Pads

Alchohol Prep Pads (Box)

Band-Aids (Latex Free)(Box)

Needle Holder Plastic(5/bag)

Stool Culture Kits(10/bag)

Ova & Parasite Stool Kit

Blood Culture Tubes(10/bag)

Nasopharyngeal Swab(50/bag)

URINE COLLECTION

Urine Analysis Tube 8.5 m (10/bag)

24 Hour Urine Containers (10/bag)

Urine Cups( Non-sterile plastic w/ho lid) (100/bag)

Urine Transfer Straw Kit (10/bag)

Urine Culture Tubes (10/bag)

TOXICOLOGY

Urine Drug Screen Cups(10/bag)

Oral Fluid Collection Swab(25/box)

GLOVES

(For Clarity Employees Only)

Small

Medium

Large

Comments