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Order Supplies Form

 

Office Code/Name and Address*
Required by/Date*
Phone:*
Requestor Name:*
Last Order Date:

Requisitions/Bags
Requistions needed:
Specimen Bags (100/pk)
Transport bags LG (50/pk)

Biopsy Collection
20 mL Formalin Jars (100/case)
90 mL Formalin Jars (100/case)
40 mL Formalin Jars (100/case)
120 mL Formalin Jars
1/2 gal Formalin Jars
DIF/Immuno fixative (Michel's) Green Top
RPMI (1 ea)
95% Alcohol slide holders (15/pk)
Bone Marrow Collection kit (1 ea)
Prostate biopsy collection kit 6 pt (1 ea)

Blood/Urine/Culture Collection
Cytology Kit (1 ea)
SST (Red Tiger Top) 100/cube
K2 EDTA (Lavender) 100/cube
NaCitrate (Light Blue) 1 ea
Heavy Metal (Dark Blue) 1 ea
Sterile Urine Cups(White) 1 ea
Urine Culture Tubes(Grey) 1 ea
Vacutainer Adapters (Clear) 1 ea
22G Needles (48/box)
21G Needles (48/box)
Bacterial/Fungal Culture Swabs (Pink) 1 ea
Universal Viral Transport (Purple) 1 ea
ThinPrep vial, with brushes (24/tray)
Details (if any)

Hours & Info
Address:  28100 North Ashley Circle, suite 106, Libertyville, IL 60048
Ph:  847-996-1030  |  Fax:  847-996-0791  
Monday - Friday  |  8:00 am - 5:30 pm



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