Hospital & Neighborhood Outpatient Laboratories
Hospital & Neighborhood Outpatient Laboratories

Community Physician Office Supply Order Form

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

Remember to check our Test Directory to ensure you are following proper specimen collection instructions and using correct swab, tube, or vessel.

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

Liquid Amies E-swab transport [Use for most cultures: Anaerobic, Wound, Ear, eye, genital, and respiratory quant cultures]

PK (50) Swabs

Standard dacron/polyester (LQ STUART) swab {REPLACES Red Top Swab} [Use for Rapid Flu A/B nasal specimens, Staph Screen Molecular, Thrichomonias antigen, Yeast & Clue Cell Stain, Cryptosporidium sp PCR, Entovirus PCR, VZV PCR, HSV PCR]

50/pk

Dry Sterile Foam Tip Swab [Use for Rapid COVID 19 nasal specimens, Rapid Group A Strep- Molecular throat specimens only]

Box (100) Swabs

Flexible shaft minitip (LQ STUART) swab [Use for Rapid COVID nasopharyngeal specimen, Rapid Flu A/B Molecular nasopharyngeal specimen, Rapid RSV Molecular nasopharyngeal specimen, Adenovirus PCR, Pertussis PCR, Chlamydia Pheumoniae PCR, COVID/Flu PCR, EBV

50/pk

Xpert Swab Specimen Collection Kit (Cervical / Endocervical)

Each

Aptima Multi-test Swab: Orange package with Pink Swab (Eye, Throat, Rectal, Vaginal)

Each

Aptima Unisex Swab: Purple package with Blue Swab (Male Urethral/Female Endocervical)

Each

Liquid VTM/UTM (M6) swab transport [Use for Rapid COVID/FLU, Rapid COVID/FLU/RSV, check test directory for more]

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

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

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

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Community Physician Office Supply Order Form

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Hospital & Neighborhood Outpatient Laboratories
Hospital & Neighborhood Outpatient Laboratories