Clinical Laboratories
Order Form

Community Physician Office Supply Order Form

Community office personnel: Please complete the following form to request supplies.

Thank you.

* fields are required

Contact Information

Office Location

* Email Address

* Contact Name

* Contact Phone Number

Item:

How Supplied:

Quantity Requested:

Microbiology

SABHI with CC for dermatology culture

PK (10) Plates

Thayer Martin for Neisseria gonorrhea culture

PK (10) Plates

ESwab White or Purple (Anaerobic Cultures and Wound Cultures)

PK (50) Swabs

Red Top Swab (HealthLinks)

50/pk

Blue Top or White Top Puritan Swabs (Rapid Group A Strep Molecular Throat source, Covid-19 nasal source, Rapid Flu A and B Molecular Nasal source)

Box (100) Swabs

Green Top Swab (Nasopharyngeal/NP, Covid-19, Rapid RSV, Rapid Flu A, Flu B Molecular)

50/pk

Xpert Swab Specimen Collection Kit (Cervical / Endocervical)

Each

Aptima Orange Swab (Eye, Throat, Rectal)

Each

Aptima Purple Swab (Male Urethral / Eye, Throat, Rectal)

Each

UTM Transport Media

Each

Para-Pak for Stool Culture

Box (20) Vials

Para-Pak for Ova and Parasites

Box (20) Vials

Blood Culture Bottle Aerobic Yellow Cap

Each

Blood Culture Bottle Anaerobic Purple Cap

Each

Urine

Sterile Urine Cups

Each or Case of 300

Urine collection cup w/transfer device

Each

Urine U-Bag Collectors

Each

Grey Tube for Urine Culture

Each

Red/Yellow Tube for Urinalysis

Each

Phlebotomy

Lead Specimen Card

Pack (100) Cards

Vacutainer Adapters

Bag (250) Adapters

Tourniquets

Box (25) Tourniquets

MicroTainer Extender

PK (50) Extenders

Heel Warmers

Box (25) Warmers

Blood Collection Needles

Vacutainer Blood Collection: Butterfly 21G

20/Pkg

Vacutainer Blood Collection: Butterfly 23G

20/Pkg

Vacutainer Blood Collection: Butterfly 25G

20/Pkg

Chemistry and Hematology

MicroTainer Lancets Newborn 1.8mm

Box (200) Lancets

MicroTainer Lancets Pediatric 2.0mm

Box (200) Lancets

MicroTainer Lavender

Bag (50) Tubes

MicroTainer Red

Bag (50) Tubes

MicroTainer Green

Bag (50) Tubes

MicroTainer Yellow

Bag (50) Tubes

Vacutainer: Lavender

Tray (100) Tubes

Vacutainer: Gold

Tray (100) Tubes

Vacutainer: Lime Green

Tray (100) Tubes

Vacutainer: Green

Tray (100) Tubes

Vacutainer: Red

Tray (100) Tubes

Vacutainer: Tan

Tray (100) Tubes

Specimen Transport and Order Forms

Specimen Bags

PK (100) Bags

Specimen Bags (STAT)

PK (100) Bags

Ancillary Order Forms

Pad (50 Forms)

Ancillary Order Forms - Allergen

Pad (50 Forms)

Other

Clinical LaboratoriesOrder Form

Community Physician Office Supply Order Form

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Clinical Laboratories
Order Form