Clinical Laboratory Partners Online Supplies Order Form

CLIENT SUPPLY ORDER FORM

Client ID:		Street:
Client Name:		Town:
Contact Name:		Phone:
Email:

BLOOD COLLECTION SUPPLIES

UNIT

QTY

VACUTAINER TUBES(continued)

UNIT

QTY

Alcohol Pads*

Green Top Na-Heparin 4ml

Band Aids (strips)*

Green Top Na-Heparin 6ml

Band Aids (spots)*

Green Top Na-Heparin 10ml

Gauze Pads 2x2*

PKG

Gray Top 2ml

Tourniquets - Latex Free

Green Top 10ml Lith Hep for Quantiferon

Needle Holders (25/bag)

GLUCOSE TOLERANCE TEST

UNIT

QTY

NEEDLES-VACUTAINER

UNIT

QTY

Orange Flavor Glucola 50g

21G 1" Needles (100/box)

Orange Flavor Glucola 100g

21G 1 1/2" Needles (100/box)

Fruit Punch Flavor Glucola 100g

CYTOLOGY/PAP SUPPLIES

UNIT

QTY

MICROBIOLOGY SUPPLIES

UNIT

QTY

**Thin Prep Vials (25/tray / 250/box) w/brushes & spatulas

PK/25

Affirm BV 10/bx

**Thin Prep Vials (25/tray / 250/box) w/cervical brooms

PK/25

Routine Culture BBL Swab Plus (blue)

Thin Prep Patient Brochures

Mini-tip Culturette (orange)

**Surepath Vials w/ Brush & Spatula

PK/25

Rapid Group A Strep Swab (red)

**Surepath Vials w/ Cervical Broom

PK/25

GC/Chlam. Aptima Urine Collector (Yellow)

Surepath Patient Brochures

GC/Chlam. Aptima Swab Collector (Purple)

Viral/Chlamydia/Mycoplasma Culture (M4 Media)

PATHOLOGY/BIOPSY SUPPLIES

UNIT

QTY

Blood Culture Bottle Sets(blue & yellow)

60ml jar w/10% Formalin

Sterile Specimen Cups (100/bag)

20ml jar w/10% Formalin

U/A Red/Yellow top tube w/Transfer Device

240ml jar w/10% Formalin

Urine C&S Gray top tube w/Transfer Device

O & P Kit for Stool (10/bx)

FORMS

UNIT

QTY

FOBT-Chek Patient Mailer (20/bx)

Supply order forms

Medicare Waiver forms

GENERAL LABORATORY SUPPLIES

UNIT

QTY

HIV Consent forms

Light Protected Pediatric tubes

1-ply Clinical Req. Form # 10

Specimen Bags (regular) 100/pk

2-ply Clinical Req. Form # 10A

Specimen Bags (special hand.) 100/pk

1-ply Custom Req. Form # 10B

Specimen Bags (stat) 100/pk

2-ply Custom Req. Form # 10C

Castile Soap Towelettes (100/box)

Cytology Requisition Form # CYT19

Printer Paper Form 7A (CLP Logo) 6pks/cs

PK/500

Pathology Requisition Form # 6909

Printer Model / Toner:

24 Hour Urine Container

VACUTAINER TUBES

UNIT

QTY

Corvac 9ml SST tube

MISCELLANEOUS ITEMS

UNIT

QTY

Red Top plain 10ml tube

Red Top Plain 7ml tube

Blue Top coagulation 4.5ml

Lavender Top 4ml plastic tube

Yellow Top-ACD solution A

Pedi 3 ml SPS yellow top tube

8.3ml SPS yellow top tube

HH Blood Bank 6ml pink top

*All Blood Collection supplies are restricted to offices who perform in-office phlebotomy for specimens collected for CLP.

**Cervical collection devices cannot be ordered independently of vials.