Stores Order Form

STORES ORDER FORM

Phone: 07 578 7073 or 0800 728 4522

Fax: 07 571 1429

Practice Name:

Order Placed By:

Order Number: Date Ordered:

DELIVERY INSTRUCTIONS: please specify regular courier

will pick up from:

Laboratory Supply List
Please be mindful of expiry dates, usage and stock rotation when ordering stores.
Product / Unit / No. Req’d / Product / Unit / No. Req’d
Laboratory Request Forms / 1 pad / Chlamydia Testing
Biohazard Bags / roll 15 / Urine Kit / pkt 10
Vacutainer Tubes / Female Swab Kit / each
SST 5 ml (Gold Top) / each / Cytology
tray 100
EDTA 4ml – Haematology (Purple Top) / each / Surepath Vials / tray 25
tray 100
EDTA 6ml – Transfusion (Pink Top) / each / Rovers Cervex-Brush (Broom) / pkt 25
tray 100
Citrate 2.7 ml - Prothrombin (Blue Top) / each / Rovers Cervex-Brush Combi-Sampler / pkt 25
tray 100
Fluoride 6ml (Grey Top) / each / Cytobrush / Plastic Spatula Combo / pkt 25
tray 100
Needle Holder - Pronto Quick Release / each / Histology
Vacutainer Eclipse Needles 21 G / pkt 48 / Formalin (10%) pre-filled 70mL pot
(Red Top) / pkt 6
Blood Culture Set including wipe & butterfly needle / each / Polycose Screen
Specimen Collection Containers / Carbotest 50gm / each
Urine plastic collection dishes / each / Sharps Containers
Urine Tube - microscopy and culture
(Tan Top) / each / Sharps Container 1.4L $15.00 / each
tray 100
Urine Tube - Micro Albumin
(Yellow Top) / each / Sharps Container 5.1L $25.00 / each
tray 50
24 hr urine bottle / each / Sharps Container 7.6L $25.00 / each
TB Urine bottle / each / Miscellaneous:
Faeces containers / bag 50 / Tourniquet $20.00 / each
Sputum / Semen Container (Yellow Top) / each / Metal Holder for Urine Collection dishes
$30.00 / each
bag 25
Skin Scrape Collection Kit
including Mycology Envelope and blade / each / OTHER: Please specify
N.B. Specimen Collection Instructions are available on our website
Swabs
Culture swabs (White top) / each
pkt 50
Viral Swabs / each
ENT Swab (Orange) / each

Updated October 2017 www.pathlab.co.nz