Client Supply RequisitionRed fields required
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Client Name: Town:
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REQUISITION UNIT /  QTY
Supply order forms CLP-45 EA
1-ply Clinical Requision CLP-10 EA
2-ply Clinical Requision CLP-10A EA
1-ply Custom Requision CLP-10B EA
2-ply Custom Requision CLP-10C EA
1-Ply Laser Printed Requisition EA
1-ply Cyto/Tissue Requision CLP-19 EA
2-ply Cyto/Tissue Requision CLP-19A EA
3-ply Pathology Requisition CLP-35 EA
3-Ply Drug Screening (ADRC use only) CLP-10D EA
3-Ply Dermatopathology Requisition CLP-50 EA
3-Ply Urology A/P Requisition CLP-40 EA
1-Ply Cytogenetics Requisition CLP-80 EA
1-Ply Molecular Genetics Requisition CLP-90 EA
FORMS UNIT /  QTY
Irreplaceable Specimen Form EA
ABN Medicare Waiver Form EA
BLOOD COLLECTION TUBES UNIT /  QTY
Tube, Blue Coag 2.7 mL (formerly 4.5 mL) EA
Tube, Red/Gray 8.5ml SST Single-Gel EA
Tube, Red 7 mL No Additive EA
Tube, Red 10 mL No Additive EA
Tube, Green Top Sod Hep 4 mL EA
Tube, Green Top Sod Hep 6 mL EA
Tube, Green Top Sod Hep 10 mL EA
Tube, Pedi Yellow 3.3 mL SPS EA
Tube, Vac Gray 2 mL EA
Tube, Vac Lavender 4 mL EA
Tube, Pediatric Yellow 3.3 mL EA
Tube, Capiject Pedi-Lavender EA
Tube, Vac Pink 6 mL EA
Tube, Vac Yellow 8.3 mL SPS EA
Tube, Yellow ACD Solution A Vacutainer EA
Quantiferon In-Tube Collection Kit EA
BLOOD COLLECTION SUPPLIES UNIT /  QTY
Alcohol Prep Pads BX
Bandaids-Strips BX
Bandaids-Spots BX
Gauze 2x2 8 Ply 200/Bag BG
Needle 21g Green Safety Butterfly 50/bx BX
Needle 23g Blue Safety Butterfly 50/bx BX
Needle Eclipse Green 21g 1-1/4" 48/bx BX
Needle Eclipse Black 22g 1-1/4" 48/bx BX
Needle Holder Single Use EA
Sharps Container 1/2 Gal EA
Sharps Container 5.4 Qt EA
Sharps Container 8 Qt EA
Tourniquet Blue Latex Free EA
GLUCOSE TOLERANCE TESTING UNIT /  QTY
Orange Flavor Glucola 50g EA
Orange Flavor Glucola 75g EA
Orange Flavor Glucola 100g EA
URINE & STOOL COLLECTION SUPPLIES UNIT /  QTY
24hr Urine Container EA
Cup, Green Sterile Specimen 90 mL EA
Cup Non-Sterile Urine Collection (100/sleeve) SLV
Lid For Non-Sterile Urine Collection Cup (100/sleeve) SLV
FOBT Polymedco Patient Pak EA
Parapak Ova & Parasite (O&P) Kit EA
Stool Culture & Sensitivity (C&S) Orange Vial EA
Urine/Stool Hat - Commode Spec System EA
Urinalysis Red/Yellow Tube 8 mL No Transfer Straw EA
Urine Gray Culture Tube No Transfer Straw EA
Urine Transfer Straw EA
MICROBIOLOGY SUPPLIES UNIT /  QTY
Affirm VPIII 10/bx BX
Aptima Urine Collection Kit Yellow EA
Aptima Unisex Swab Kit Purple EA
Bactec Blood Culture Bottle Set Gray & Purple SET
H Pylori Breathtek Ubit Collection Kit EA
ESWAB Blue Cap Swab (220532) EA
ESWAB White Cap Swab (220245) EA
Swab MRSA Red Liquid Stuart Dbl Scored EA
Universal Viral Transport Media (Pink Liquid, M4) EA
CYTOLOGY/PATHOLOGY SUPPLIES UNIT /  QTY
Cervical Broom 25/pk PK
Cytology Brush-Conventional EA
Formalin 10% 20 mL Jar EA
Formalin 10% 60 mL Jar EA
Formalin 10% 240 mL Jar EA
SurePath Vial with Broom 25/pk PK
SurePath Vial with Brush & Spatula 25/pk PK
ThinPrep Vial with Cervical Broom 25/pk PK
ThinPrep Vial with Brush & Spatula 25/pk PK
ThinPrep Brush & Spatula Only-(No Vial) PK
GENERAL LABORATORY SUPPLIES UNIT /  QTY
Centrifuge Drucker 6-place EA
Report Paper CLP-7A 500/pk PK
Specimen Bag CLP Logo 100/pk PK
Specimen Bag STAT 100/pk PK
Towelette Castille Soap BX
PRINTING SUPPLIES UNIT /  QTY
OKI Drum EA
HP49A Toner EA
HP53A Toner EA
OKI B4600 Toner EA
MISCELLANEOUS ITEMS UNIT /  QTY
Specimen Box EA
Stickers-FROZEN EA
Stickers-SLAB EA
Stickers-STAT EA
Clinical Laboratory Partners reserves the right to supply only those items that are used to collect, preserve, and transport specimens to our laboratory for testing. Quantities shipped are to be in proportion with the amount of specimens received.
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