Client Supply Order Form Client Supply Order Form * - required fieldsRequestor Name* Client Name* Email* Address* Department* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip* Requisitions/PaperworkSurgicalSelect30 ea60 ea90 ea120 eaOB/GYNSelect30 ea60 ea90 ea120 eaGISelect30 ea60 ea90 ea120 eaHospitalSelect100200HemeSelect30 ea60 ea90 ea120 eaSpecimen Log Sheets Specimen Log Sheets Surgical Tissue FixativesRPMI FixativeSelect1 ea2 ea3 ea4 ea5 ea - Formalin20sSelect1 box2 boxes3 boxes4 boxes5 boxes40sSelect1 box2 boxes3 boxes4 boxes5 boxes60sSelect1 box2 boxes3 boxes4 boxes5 boxes120sSelect1 box2 boxes3 boxes4 boxes5 boxes5 galSelect1 ea2 ea - Non-Gyn Cytology120 SaccomannoSelect1 ea2 ea3 ea4 ea5 ea6 ea7 ea8 ea9 ea10 eaPreviously listed CytoRich Red Fluid.Saccomanno for FNAsSelect3691215Previously listed CytoRich Red Fluid.Reagent AlcoholSelect399Gout fixativeUrine Cytology FixativeSelect369Plastic Slide HoldersSelect510Transport Containers8ozSelect10 ea20 ea30 ea16ozSelect10 ea20 ea30 ea32ozSelect10 ea20 ea30 ea86ozSelect10 ea20 ea30 ea128ozSelect10 ea20 ea30 ea172ozSelect10 ea20 ea30 eaDermapaksSelect10 ea20 ea30 eaSmall Transport Bag (2in)Select1 pk2 pk3 pkToenails, skin scrapings, hair, paraffin blocks, etc.Lockbox KeysSelect1 ea2 ea3 ea4 ea5 eaParafilmSelect2"4"2" or 4" - KitsBone MarrowSelect51015RenalSelect369Small TransportSelect510 - Specimen Bags6x9Select100 ea200 ea300 ea400 ea500 ea8x10Select50 ea100 ea12x15Select50 ea100 eaMolecularCOVID-19 RT-PCR TestSelect510Aptima Multitest SwabSelect369Aptima Unisex SwabSelect369Aptima Urine Specimen CollectionSelect369GenProbe Unisex for Trichomonas VaginalisSelect369HPV OnlySelect369Herpes Simplex VirusSelect369Chlamydia/ Gonorrhea, M/F (Urine)Select369COPAN Swab (Bac.Vag/Yeast)Select51015COPAN ESwab (GBS)Select51015Gyn CytologyThinPrep Vials (white)Select1 flats2 flats3 flats4 flats5 flatsThinPrep Collection Tools Select All ThinPrep Brushes/Spatulas ThinPrep Brooms Other (Be specific) MicrobiologyBlue-tip SwabsSelect10 ea20 ea30 eaDouble Culturette Swabs with GelSterile TubesSelect10 ea20 eaSterile Saline TubesSelect10 ea20 eaViral Transport MediaSelect3 ea6 ea9 eaMisc. Slides Other item (Be specific) Δ