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* Location Name:
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Date:
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* Address:

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* City:

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* State:

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* Zip Code:

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Telephone:
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* Name of Person Requesting Supplies:

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Comments:

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TUBES

SST
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Red
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Lavender
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Dark Blue EDTA
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Dark Blue Serum
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Light Blue
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Gray
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Chlamydia GC DNA BD
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SWABS

Chlamydia GC DNA Female Probe:
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Chlamydia GC DNA Male Probe:
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M4 Swab:
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Culture Swab
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BOTTLES / CONTAINERS

Urine Container
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ThinPrep Pap Smear Bottle
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Pap Smear Papette® Brooms
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Urine Culture Transfer Straw Kit
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OTHER

Clinical+ThinPrep+Surgical Pathology
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Needle: 21g x 1 ¼“
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Needle: 22g x 1 ¼”
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Needle Holders
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Specimen Bags (Bundle of 50)
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