Electronic Supply Form

Home
Anatomic Pathology
Clinical Pathology
Molecular Pathology
Test Directory
SiteMap
Site Search

Quick Clicks

Contact Us

Minimize

Toll Free
800.628.6816

Local
216.444.5755

Fax
216.444.0460

E-mail
ClientServices@CCF.org

Client Services • Electronic Supply Form

Electronic Supply Order Form

Forms and Supplies | Electronic Supply Order Form

Please make sure to provide client information and select the quantity for desired items below.

Facility Name:*

Date:*

Client Mnemonic:*

Phone No.:*

First Name:*

Last Name:*

Collection Tubes

Media/Culture Kits

Grey Hemogard, Na Fluoride/K Oxalate, 4 mL

Blood Culture Bottles (Orange Top - Anaerobic)

Green Hemogard, Li Heparin, 4 mL

Blood Culture Bottles (Green Top - Aerobic)

Green Na Heparin, 4 mL

C&S Urine Transport Kit (Sterile)

Green Na Heparin, 10 mL

Kit, Aptima for Gonorrhea / Chlamydia

Navy Blue Hemogard, K2 EDTA, 6 mL

Kits, Ova & Parasites (PVA & Formalin)

Navy Blue Plain Hemogard, 6 mL

M-4 Viral Transport Media (keep refrigerated)

Pink Hemogard (Blood Bank), EDTA, 6 mL

Michelle's Media

Light Blue Coag Sodium Citrate, 3.5 mL

Glutaraldehyde (3.75%) for E.M.

Light Green PST, 4 mL

Biopsy Bottle (40 mL; 10% Formalin)

Gold top SST Hemogard, 5 mL

PAP Test: Pap Pak pk 25

VIP (Trasylol), qt 1-10

PAP Test: Thin Prep (Cytyc) pk 25

White Hemogard (PPT), EDTA, 5 mL

Cytology Collection Devices, Brooms

Yellow ACD (glass) Solution A, 8.5 mL

Cytology Collection Devices, Brushes/Spatula

Red (Serum) No Additive, 6 mL

Pyruvic Acid Test (12% TCA) 2 mL

Lavender EDTA, 4 mL

Pyruvic Acid Test (12% TCA) 4 mL

Kit Digene for HPV

Specimen Containers/Bags

Forms/Miscellaneous

Biohazard Specimen Bags (Large)

Advance Beneficiary Notice pk

Biohazard Specimen Bags (Small)

Advance Beneficiary Notice (instructions) pk

Serum Transport Tubes (Orange Top)

Printer Cartridge specify model number

Serum Transport Tubes (Light Sensitive)

Cartridge number

Specimen Transport Rack

Report Paper reams

Stool Container, 1 g (with lid)

Requisition, Anatomic Pathology

Urine Container (24 Hour; Graduated with Lid)

Requisition, Cystic Fibrosis

Urine Transport Tubes (Plain Blue Top)

Requisition, Cytology

Requisition, Dermatopathology

Pinworm Kit

Requisition, Flow

RPMI Transport Media, 5 mL

Requisition, Heavy Metals

RPMI Transport Media, 10 mL

Requisition, Home Health Care

Requisition, Hospital

Requisition, Physician

Requisition, Prenatal

Labels, specify type and number ( ) room ( ) refrig. ( ) frozen ( ) flow

Physician Office Supplies

Tourniquet

Needles (specify size)

Needle Hubs

Additional Items:

* Required

Search Test Information

A B C D E F G H I J K L M N

O P Q R S T U V W X Y Z

1 2 3 4 5 6 7 8 9 0

Search

Privacy Statement | Terms Of Use