PATHOLOGYCYTOLOGY SUPPLY ORDERING LIST by oyc99684

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									                                    Fax number: 389-5723

Thin Prep Tray Set                                 Trays (#25 vials per tray)
Includes: brushes & spatulas

Thin Prep Tray Set                                 Trays (#25 vials per tray)
SPECIAL: For Pregnant patients – brooms included
Pap Brushes (CE brushes)                           Package(s) (100 per pkg.)
Wooden Cervical Scrapers                           Box(s)
Pap-Kits                                           Box(s) (30 per box)
Hybrid Capture II HPV Test Digene                  Kit(s)
Pap Smear Requisitions Forms                       Package(s) (50 per pkg.)
Advanced Beneficiary Notice (ABN)                  Package(s) (200 per pkg.)
Pathology Forms – Physician Office                 Package(s) (50 per pkg.)
Pathology Forms – Hospital                         Package(s) (50 per pkg.)
Slide Holders – Cardboard                          Box(s)
10% Neutral Buffered Formalin                      [ ] 20ml [ ] 40ml [ ] 120ml
Bottles                                                     [ ] Gallon
Designate quantity and size

Specimen Containers (white)                        [ ] 16 oz [ ] 32 oz [ ] 64 oz
Designate quantity and size
                                                    [ ] 86 oz [ ] 172 oz
Cytology Fixative Spray                            Bottles
Cytolyt                                            Bottles
Parafilm                                           Each
Specimen Bags                                      Package(s)
Slides                                             Boxes


Ordered by: ____________________                   Phone #:_________________

Date Ordered: _____________________

Physician/Facility: __________________ Address:_________________

								
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