Medical supplies order form Medical supplies order form Contact name(Required) First Last Email(Required) Surgery name / Ward location(Required) Address(Required) Street Address Address Line 2 City ZIP / Postal Code REQUISITION PADS Yes Requisition pad Name for requisition pad TUBES Yes ACD 6mL Blue 2.7mL Blue 1.8mL Blue mini-collect Blood culture sets CPDA tube 9mL ESR tubes (black top) Green (heparin) 2mL Green (heparin) 4mL Grey (fluoride) 2mL Illumi (Streck) tube Lavender (EDTA) 2mL Lavender (EDTA) 4mL Lavender (EDTA) microtainer Mint 4.5mL Mint (PST LH) microtainer Navy (K2EDTA) 6mL Pink (cross match) 6mL Red tube 2mL Red tube 6mL Yellow (SST) 5mL Yellow (SST) microtainer NEEDLES Yes 21 gauge (green) 22 gauge (black) SWABS Yes APTIMA urine chlamydia APTIMA swab chlamydia Viral/FLOQ dry swab (orange top) Routine culture swab (purple top) Urethral swab COVID PCR swab Specimen containers Yes 24-hour urine container (acid) 24-hour urine container (plain) Faeces containers (scoop) Paediatric urine bags Specimen pottles (lavender top) Urine collection punnett Urine tubes (white lid) HISTOLOGY / CYTOLOGY Yes Cervix broom (Pk/25) Endo scan + brush (Pk/10) Spatula (each) SurePath vial kit (Tray/25) HPV self-collect swab only (Copan 552C) – Each Urine cytology (pottle) Formalin containers (70mL) SUNDRIES Yes Alcohol wipes Glucose for polycose (50g) Glucose for GTT (75g) Biohazard specimen bags White transport bags OTHER REQUIREMENTSDate of order(Required) DD slash MM slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
