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Client
*
Department
Full Name
*
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*
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General Supplies
Small Specimen Biohazard Bag
100 per pack
0
1
2
other
Small Specimen Biohazard Bag Quantity
Large Specimen Biohazard Bag
100 per pack
0
1
2
other
Large Specimen Biohazard Bag Quantity
Specimen Logbook
0
1
other
Specimen Logbook Quantity
Other Items
Requisition Form (pack)
Breast Time Sticker
Histology Supplies
20ml Prefilled Formalin Container
0
1
2
3
4
5
Other
1 tray = 64 vials
Amount:
40ml Prefilled Formalin Container
0
1
2
3
4
5
Other
1 tray = 36 vials
Amount:
60ml Prefilled Formalin Container
0
1
2
3
4
5
Other
1 tray = 36 vials
Amount:
5 gallon Carboy(cube) of Formalin
0
1
2
Other
Amount:
16oz Empty Specimen Container
0
12
24
Other
Amount:
32oz Empty Specimen Container
0
12
24
Other
Amount:
86oz Empty Specimen Container
0
1
2
Other
Amount:
172oz Empty Specimen Container
0
1
2
Other
Amount:
5 gallon empty specimen container
0
1
Other
Amount:
Cytology Supplies
Gyn ThinPrep Kit
0
10
20
50
100
250
Other
Amount:
Box of Glass Slides
0
1
2
3
4
5
Other
Amount:
Two-Slot SLide Folders
0
10
20
30
Other
Amount:
Twenty-Slot Slide Folders
0
5
10
15
20
Other
Amount:
Spray Fixative
0
1
2
3
Other
Amount:
946ml Bottle Cytolyt Preservative
0
1
2
3
4
Other
Amount:
50ml Non-gyn Cytolyt Collection Tube
0
5
10
15
20
Other
Amount:
UroVysion FISH collection kit
0
5
10
15
20
Other
Amount:
Sterile Urine Collection Cup
0
10
20
30
Other
Amount:
Afirma Thyroid Collection Tubes
0
6
12
18
24
Other
Amount:
Afirma Specific Requistions
0
6
12
18
24
Other
Amount:
Molecular Pathology Supplies
Aptima Unisex Swab Collection Kit (white)
0
5
10
15
20
50
Other
Amount:
Aptima Urine Collection Kit (yellow)
0
5
10
15
20
50
Other
Amount:
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