CALL OR FAX TO CLIENT SERVICES AT:
SUPPLY REQUEST FORM
Phone: 541.687.2134 / 800.826.3616
Fax: 541.341.8067 / 866.511.5963
Email: [email protected]
www.peacehealthlabs.org
Supplies are delivered to clients only for
collection, transport and report of testing sent to PeaceHealth Laboratories
CLIENT NAME
CLIENT #
ADDRESS
BLOOD TUBES, VACUUM TUBES
Green 4 mL (LiHp)
DATE
PHONE #
PART# PKG QTY TISSUE SUPPLIES**
3193
Each
ORDERED BY
PART# PKG QTY PRENATAL TESTING
PART# PKG QTY
10 mL Formalin – sz 20 Bottle
113130
Natera Cystic Fibrosis Kit
131830
Each
Each
Each
Green 4 mL (NaHp)
92659 Each
20 mL Formalin - sz40 Bottle
100564 Each
Natera Panorama Kit
131828
Green 10 mL (NaHp)
92660 Each
30 mL Formalin - sz60 Bottle
100565 Each
Natera Requisition
131747
Each
Grey 2mL Na Fluoride/K Oxalate
28106
Each
60 mL Formalin - sz120 Bottle
100566 Each
Panorama Requisition
131748
25/pk
3195
Each
90 mL Formalin - sz120 Bottle
93521
Each
Cystic Fibrosis Requisition
131731
25/pk
Pathology Labels-Formalin Bottles
98904
Each
PtPROTECT™ TESTING
PART# PKG QTY
Derm Path Kit, 5 mL Pre-filled Formalin
101705
Each
Urine Cup with Temp Strip
89499
Each
iCup Collection (Test Lid)
114047
Each
Grey, 4mL Na Fluoride/K Oxalate
Grey, 6mL Na Fluoride/K Oxalate
92654 Each
Lavender 2 mL, Hemogard (EDTA)
3187
Each
Lavender 4 mL (EDTA)
3190
Each
Light Blue 1.8 mL (Na Citrate)
3153
Each
Light Blue 2.7 mL ( Na Citrate)
3154
Each
SPECIMEN COLLECTION
Light Blue 4.5 mL (Na Citrate)
3208
Each
Glucola 50 gm (Lemon)
81605
Each
Light Green 4.5 mL PST (LiHp)
3198
Each
Glucola 75 gm (Orange)
83246
Each
**Supplies on behalf of Northwest Pathology Services (NPS)
for testing done at NPS
iCup (Temp Cup/Plain Lid) 116657 116659 Each
PART# PKG QTY PRINTER RIBBONS/TONER PART# PKG QTY
Microtainer, Lav
92338 50/pk
Glucola 100 gm (Lemon)
83245
Each
Microtainer, PST
92341
50/pk
Tourniquet
60885
25/pk
Microtainer, SST
92343
50/pk
3194
Each
Pink 6 mL (EDTA)
Red 5 mL, No Additive, Serum
SST 5 mL, Gold Cap
SST 7.5 mL, Red/Grey Cap
28836 Each
List Printer Make and Model:
Each
TRANSPORT SUPPLIES
PART# PKG QTY
Ice Pack
95365
Each
80419
Each
Frozen Specimen Container
MICROBIOLOGY SUPPLIES
PART# PKG QTY 10X13 Routine Spec Bags
113126 100/pk
Anaerobic Transport Tube
91065
Each
10X13 Stat Spec Bags
113129 100/pk
3199
Each
Blood Culture, Aerobic (Green)
3367
Each
6X10 Routine Spec Bags
149332 100/pk
92451
Each
Blood Culture, Anaerobic (Orange)
3368
Each
6X10 Stat Spec Bags
149326 100/pk
Blood Culture, Pediatric (Yellow)
3372
Each
STICKERS/LABELS
PART# PKG QTY
110525
Each
Stat
99004
Roll
Royal Blue 6 mL, No Additive, Serum 80465
Each
Mini-Tip Culture Swab
94032
Each
Specimen Label
98904
Roll
Royal Blue 6 mL K2 EDTA (Metal Free) 80466
Each
Ova and Parasite Kit w/Instructions
132296 Each
FORMS/PAPER
PART# PKG QTY
Tan 3 mL EDTA (Metal Free-Ped Lead Only) 92658
Yellow 8.5 mL (Sol A)
3124
Each
Rayon Swab-Rapid Strep A, Rapid Strep
B, Trichomonas ag, (order with 82807)
4Medica Requisition Paper
85073
SPECIALTY VACUUM TUBES
PART# PKG QTY C&S Medium (Enteric Transport)
Each
59341
Each
FAX Order/Add-On Test Req
Ream
Call Client Services
Yellow 6 mL (Sol B)
92556 Each
Routine Culture Swab
81624
Each
Laser Report Paper
85071
Ream
Yellow 2.6 mL (Sol B)
92656 Each
Stool Collection Container
82804
Each
Specimen Log Book
110529
Each
82807
100/pk
Supply Request Form
110557 Tablet
110560
Each
22 g
Transport Tube for Swab
PART# PKG QTY Wet Mount Kit
MISCELLANEOUS SUPPLIES
108177 100/bx
Affirm VP III Transport System
108178 100/bx
Vacutainer Safety Holder
91942
CYTOLOGY SUPPLIES
PART# PKG QTY Chlamydia/GC Urine Transport
SurePath Brush/Spatula Only
125237 25/pk
H. Pylori Urea (HP Fast Kit)
SurePath Brooms Only
125227 25/pk
HPV Cervical Sampler Kit
SurePath Collection Vials Only
125228 25/pk
ThinPrep Brooms Only
98304 25/pk
ThinPrep Brush/Spatula Only
98305 25/pk
MicroTest™ (M4RT) (Red)
ThinPrep Kit/Vials & Brooms
98306 25/pk
Transport Media
ThinPrep Kit/Vials & Brushes
98307 25/pk
Pertussis PCR (order M4RT)
Semen Specimen Collection
112773
25/pk
PAP Pak Kit (1 slide)
82644 25/bx
QuantiFERON-TB Gold Collection
Kit (Limit 10)
Sperm Washing
109145
25/pk
Sputum Collection
109150
25/pk
Stool Collection Info
131654
25/pk
VACUTAINER NEEDLES- MULITSAMPLE
21 g
URINALYSIS SUPPLIES
24 hr Urine Container
Test/Preservative
100/bx
PART# PKG QTY
100342 Each
24 Hour Urine Collection
112772
25/pk
31700
Each
24 hour Urine Collection
95370
(Spanish)
109147
25/pk
Each
Easy Access Flyer-Oregon
120970
50/pk
Easy Access Flyer-Spanish
113537
50/pk
MicroTest™ (M4) (Blue) Transport
Easy Access Flyer-Women
117746
50/pk
Media for Mycoplasma and Ureaplasma
Glucose 1-Hour Gest Tol Test 129268
Maps – Oregon PSC
104557
100/pk
Chlamydia/GC Unisex Swab
PART# PKG QTY Serum Transfer Tube 13x75
(order with 113155)
10711
Each
120492
100/pk
Serum Transfer Tube Red Cap
(order with 103588)
BD UAPreservative Tube (w/straw)
91062
Each
Universal Viral Transport
Nun's Hat (pan speci)
82350 Each
Urine Cups - Sterile, 5 oz
80242 Each
Antiseptic Towlettes
PART# PKG QTY BROCHURES
for Viruses, Chlamydiae, Mycoplasmas
and Ureaplasmas (includes flocked
swabs and transport tube)
T: Publications/Supplies/Forms/SUPPLY REQUEST FORM STANDARD
Call Client Services
105079 Each
Order Universal
Viral Transport
#115528
116768
Each
103588
1000/pk
113155
1000/pk
115528
Each
Prenatal Screening
25/pk
107596 100/pk
ADDITIONAL INQUIRIES/ORDERS
PRODUCT
PART# PKG QTY
LW# 110557 (10/2014)