Order Supplies

    Account Name*

    First Name*

    Last Name*

    Phone*

    Email

    Account Number

    Date Requested

    Comments

    Shipper Kits

    Block-Slide (IHC) Ship

    AP Large Ship

    AP Medium Ship

    AP Small Ship

    Collection Kits

    FNA Kit

    14 Bottle Prostate bx Kit

    Peripheral blood Kit

    Hematopathology (Bone Marrow) Kit

    Urine Cytology Kit

    PCA 3 Kit

    Collection Media/Tubes

    Zinc formalin (for Bone marrow bx)

    Green Top — Na Heparin

    Purple Top — EDTA

    Tissue Transport Media (TTM)

    Michel's Fixative for IFA

    Afirma FNAprotect vials (for Thyroid FNAs)

    Non-Gyn Cytology Supplies

    Slides for FNA — frosted end

    Slides Gold Seal

    Slides Holder Plastic Mailer

    Slides Holder/Fixative — 95% Ethanol

    Cardboard 2 slide holder

    Cardboard 20 slide holder

    Cytolyt vials 30 mL

    Histology Supplies

    Formalin — 20 mL, contains 10 mL formalin

    Formalin — 40 mL, contains 20 mL formalin

    Formalin — 60 mL, contains 30 mL formalin

    Formalin — 120 mL, contains 60 mL formalin

    Cs Tissue Container, 16 oz.

    Cs Tissue Container, 32 oz.

    Cs Tissue Container, 86 oz.

    Cs Tissue Container, 1/2 oz.

    Additional Client Supplies

    Plastic Bags, 6 x 11

    Plastic Bags, 9 x 11

    Plastic Bags, 13 x 18

    Insurance Managed Care List

    Client Tissue Log sheets

    Printer Toner — Specify Printer Model#/Color

    Requisition Forms

    Breast Requisition forms

    Dermatopathology Requisition forms

    Gastroenterology Requisition forms

    Hematopathology Requisition forms

    Podiatry Requisition forms

    Solid Tumor Requisition forms

    Surgical Pathology/Histology AP Requisition forms

    Urology Requisition forms

    Thyroid FNA Requisition forms

    FedEx Supplies

    Airbills

    Diagnostic specimen bags