NDSS Product Order Form:
Approved RAAHS Clinics and State Government Rural and Remote Clinics
Clinic Name
Postal Address
Delivery Address
(if different from
Postal Address)
Name of
Authorised Person
Date
Contact Person
Phone Number
Email
Signature of
Authorised
Person
Please supply the following NDSS products for use by our clinic to support the management of diabetes for patients under our care.
You may attach a list to this order form including the information requested below or fill out the below tables. Refer to the second page for a list of available products.
Blood Glucose Test Strips
BGTS Brand (Eg. Optium Freestyle)
NDSS Code
Quantity
Total
Pen Needles* (Boxes of 100)
Pen Needles Brand (Eg. BD 6mm or Novofine 5mm)
NDSS Code
Quantity
Total
For further information or if you require assistance in filling out this form please phone Healthy Living NT on 0889 278 488.
Once completed, please send this from to Healthy Living NT on Fax 0889 278 515 or by email to [email protected]
Blood Glucose Testing Strips
Product Description
Accu-Chek Active Blood Glucose Strips
Accu-Chek Aviva Strips 50 F2
Accu-Chek Go Reagent Strips
Accu-Chek Integra 3 x 17
Accu-Chek Mobile Test Strips (Insulin requiring only)
Accu-Chek Performa Electrode Strips
Bayer Contour Blood Glucose Test Strips
Bayer Contour NEXT Blood Glucose Test Strips
Betachek C50 Blood Glucose Test Cassette
Betachek G5 Strips
Betachek Reagent Strips
BGStar Blood Glucose Test Strips
Bionime Rightest Strips
CareSens N Reagent Strips
CareSens Reagent Strips
Dario Blood Glucose Test Strips
Easy Mate II Blood Glucose Test Strips
FreeStyle Lite Blood Glucose Test Strips
FreeStyle Optium Blood Glucose Test Strips
GoodLife Blood Glucose Test Strips
Glucoflex-R Reagent Strips
GlucoDr Blood Glucose Test Strips
GluNeo Blood Glucose Test Strips
Healthpro Blood Glucose Test Strips
MyGlucoHealth
OneTouch Verio
OneTouch Select
Sensocard
TrueBalance Test Strips
TrueResult Test Strips
TrueTrack Strips
Pen Needles
Packs Of
100
50
50
51
100
100
100
100
100
50
50
100
50
50
50
100
50
100
100
100
50
50
50
50
50
50
50
50
100
100
100
NDSS Code
22.5
135
35
39
48
107.5
140
195
246
106
08
145
47
119
38
240
180
44
27
155
26
36
244
242
02
120
160
05
125.5
130.5
37.5
Product Description
B-D MicroFine + Pen Needle 29G x 12.7mm
B-D MicroFine + Pen Needle 31G x 8mm
B-D MicroFine + Pen Needle 31G x 5mm
B-D UltraFine + Pen Needle with Pentapoint Comfort 32G x
4mm
Mylife Clickfine Pen Needle 31G x 8mm
Mylife Clickfine Pen Needle 31G x 6mm
Mylife Clickfine Pen Needle 32G x 4mm
NovoFine Pen Needle 30G x 8mm
NovoFine Pen Needle Tip 32G x 6mm
NovoFine Plus Pen Needle 32G x 4mm
Unifine Pentips 29G x 12mm
Unifine Pentips 31G x 8mm
Unifine Pentips 31G x 6mm
Unifine Pentips 31G x 5mm
Insupen Pen Needle 29G 12mm
Insupen Pen Needle 31G 8mm
Insupen Pen Needle 31G 6mm
Insupen Pen Needle 31G 5mm
Insupen Pen Needle 32G 8mm
Insupen Pen Needle 32G 6mm
Insupen Pen Needle 32G 4mm
Insupen Pen Needle 33G 4mm
Droplet Pen Needle 29G 12mm
Droplet Pen Needle 29G 10mm
Droplet Pen Needle 31G 8mm
Droplet Pen Needle 31G 6mm
Droplet Pen Needle 31G 5mm
Droplet Pen Needle 32G 8mm
Droplet Pen Needle 32G 6mm
Droplet Pen Needle 32G 5mm
Droplet Pen Needle 32G 4mm
Packs of
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
NDSS Code
87
92
97
101
217
216
231
91
150
165
215
214
213
235
250
252
254
256
258
260
262
264
270
272
274
276
278
280
282
284
286
100
100
100
100
100
100
100
100
76
77
88
89
90
201
202
203
Syringes
Terumo 0.5mL 29G x 13mm
Terumo 1.0mL 29G x 13mm
B-D Ultra-Fine 0.3mL 29G x 12.7mm
B-D Ultra-Fine 0.5mL 29G x 12.7mm
B-D Ultra-Fine 1.0mL 29G x 12.7mm
B-D Ultra-Fine ll 0.3mL 31G x 8mm
B-D Ultra-Fine ll 0.5mL 31G x 8mm
B-D Ultra-Fine ll 1.0mL 31G x 8mm