Inventory Order

Physician's Name

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Account Number

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Office Street Address

Address 2

City

State

Zip

Office Phone

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Tubes

Red (Plain Red tubes)

QTY

SST (Marble top tubes)

QTY

Lavendar (EDTA)

QTY

Light Blue (Sodium Citrate)

QTY

Grey (Potassium Oxalate)

QTY

Green (Sodium Heparin)

QTY

Royal Blue (Trace Element K2 EDTA)

QTY

Transfer Tubes

QTY

Urine Culture and Sensitivity

QTY

Needles

21x1" (Box of 100)

QTY

22x1" (Box of 100)

QTY

21x1 ½" (Box of 100)

QTY

21x1 ¼" (Box of 100)

QTY

Butterfly Needles

21G (Box of 50)

QTY

23G ¾" (Box of 50)

QTY

25G ¾" (Box of 50)

QTY

OBGYN

Aptima swab

QTY

M4 transport tube

QTY

Starswab II

QTY

Biopsy Container

QTY

Specula

QTY

Thin Prep

QTY

Miscellaneous

Gloves, Small (S)

QTY

Gloves, Medium (M)

QTY

Gloves, Large (L)

QTY

Gauze 2x2

QTY

Gauze 4x4

QTY

Alcohol swab

QTY

Bandaid

QTY

Needle Holder

QTY

Tourniquet

QTY

Sharp Containers

QTY

24H Urine Containers

QTY

O & P Containers

QTY

Specimen Bags

QTY

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