Client Information Client Name Client Number Email Address City State Zip Routine Clinical Supplies SST 5.0 mL Red Top Tube (NO GEL) 5.0 mL Lavender Top Tube (EDTA) 2.0 mL Light Blue Top Tube 2.7 mL Gray Top Tube 4.0 mL T-Spot.TB PCR Green Tube 6.0 mL Defibrillator Tube Driver Needle 21g x 1 1/4 Needle 23g x 1 Butterfly 21g x 3/4 x 12" Butterfly 23g x 3/4 x 12" Vacutainer Holder Tourniquet Cotton Balls Surgical Tape Alcohol Pads Bandages/Gauze Pads Coban Specimen Bags 6x9 HIPAA Decals/Slips Glucose Beverage 50g Glucose Beverage 75g Glucose Beverage 100g Gloves Small Gloves Medium Gloves Large Gloves X-Large Biohazard Sharp Container Labels Toilet Hat Centrifuge Molecular Profile Supplies COVID Swab Kits (VTM) GI Swab Kit (Fecal Swab) UTI Complete Urine Kits Toenail Fungal PCR (Conical Cup) Requisitions / Forms Clinical Requisition Custom Requisition Molecular (UTI, GI, Toenail) Toxicology Requisition COVID Requisition (PCR, RPP) Culture Swabs (Microbiology) Culture Routine (Ethin Swab) Wet Mount (Saline) E-Swab (Bacterial/Vaginal) Urine Collection Container Sterile Cup (U/A) Sterile Cup Temp Strip 24-Hour Collection Container Cytology / Histology Biopsy Small 20ML Biopsy Medium 40ML Pap Smear Sure Path Cervical Sampling Brush Cervical Spatula Dual Side Wallach Purple Broom Final Info Your Initials Notes on this order