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Community Physician Office Supply Order Form

Community office personnel: Please complete the following form to request supplies. For any questions, please contact Lab Administration at 513-636-2816. Orders will be processed on Mondays and Thursdays.

Thank you.

Contact Information

 

* fields are required 
* Office Name:     
* Office Address 1:    
Office Address 2:     
* Office City:    
* Office State:    
* Office Zip:    
* Email Address  
* Contact Name  
* Contact Phone Number (xxx-xxx-xxxx)
   

Order

 

  Item:    How Supplied   Quantity Requested 
     
Microbiology    
Sabi Agar (Mycosel) Plates PK (10) Plates  
Martin Lewis Plates PK (10) Plates  
Aerobic Culture Swabs (Red Label) PK (50) Swabs  
Anaerobic Culture Kits PK (25) Kits  
Stool Para-Pak for C/S Box (20) Vials  
Stool Para-Pak for O/P Box (20) Vials  
Viral Transport Media Each  
Blood Culture Bottle Aerobic Pink Cap Each  
Blood Culture Bottle Anaerobic Purple Cap Each  
Probetec Swabs (please specify Male or Female) Each  
     
Urine    
Sterile Urine Cups Case (10)  
Urine Vacutainer Kits - Urinalysis Case (50) Kits  
Urine Vacutainer Kits - Culture Case (50) Kits  
Urine U-Bag Collectors Box (100) Bags  
     
Phlebotomy    
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 Box (25) Needles  
Vacutainer Blood Collection: Butterfly 23 G Box (25) Needles  
Vacutainer Blood Collection: Butterfly 253/4 Box (25) Needles  
     
Chemistry and Hematology    
MicroTainer Lancets Blue Box (200) Lancets  
MicroTainer Lancets Lavender Box (200) Lancets  
MicroTainer Lavender Bag (50) Tubes  
MicroTainer Red Bag (50) Tubes  
MicroTainer Green Bag (50) Tubes  
MicroTainer Yellow Bag (50) Tubes  
Vacutainer Tube: Lavender Tray (100) Tubes  
Vacutianer Tube: Gold Tray (100) Tubes  
Vacutainer Tube: Green/Black Tray (100) Tubes  
Vacutainer Tube: Red Tray (100) Tubes  
Vacutainer Tube: Tan Tray (100) Tubes  
     
Specimen Transport & Order Forms    
Specimen Bags PK (100) Bags  
Specimen Bags (STAT) PK (100) Bags  
Ancillary Order Forms PK (250) Forms  
Ancillary Order Forms - Allergen PK (250) Forms  
Other      


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