Supply Order Form

Supply Order Form
Office / Client Name:*
Office Name, Not Account #
Office / Client Address:*
Ordered By:*
Email (Used for Notifcations):

COLLECTION SUPPLIES
Alcohol Prep Pads
200/Box
Aptima Multitest Swab-Orange
Individual
Aptima Unisex Genital Swab-White/Purple
Individual
Band Aids
100/Box
Biohazard Sharps Containers Small
Individual
Biohazard Sharps Containers Large
Individual
Biopsy Bottle - 20mL
32 per box
Biopsy Bottle - 90mL
24 per box
Coflex
Individual Rolls
Commodes/Stool Hats
Individual
Cotton Balls
Large Bag
Culture/eSwab
(50/Bag)
Glucola 50 G
6 Pack
Glucola 75 G
6 Pacck
Glucola 100 G
6 Pack
Gauze 2x2
100 per pack
Gauze 4x4
100 per pack
Gloves - Small
100 per pack / **Biotech Phlebotomists Only**
Gloves - Medium
100 per pack / **Biotech Phlebotomists Only**
Gloves - Large
100 per pack / **Biotech Phlebotomists Only**
Gloves - Extra Large
100 per pack / **Biotech Phlebotomists Only**
Fecal Occult Blood Test Kit
Box of 20
OB Towelettes
100 per box
Ova & Parasite Kits
Individual
Paper Tape
Individual
Specimen Bags - Small
50/Pack
Specimen Bags - Large
50/Pack
Thin Prep Pap Kit
25 per Tray
Thin Prep - Brushes & Brooms
25 per pack
Tourniquets
Individual
Urine Cups - Sterile (Orange)
100 per bag
Urine Cups - Non Sterile (Yellow)
100 per bag
Urine C&S Transport
Individual
Urine 24 Hour Container
Individual
Viral Transport Media (UTM or VTM)
Individual
Breath ID Bag
Pack of 5

TUBES - Please provide total quantity of tubes needed
ACD Solution A
Individual - Total Qty Needed
Amber Light Protected With Tops
Individual - Total Qty Needed
Black/Yellow Top Lipo Tube
Individual - Total Qty Needed
Blood Culture SPS
Individual - Total Qty Needed
Dark Blue Top (EDTA)
Individual - Total Qty Needed
Grey Top
Individual - Total Qty Needed
Lavender Top
Individual - Total Qty Needed
Light Blue Top
Individual - Total Qty Needed
Light Green Top
Individual - Total Qty Needed
Metal Free Pour Off Tube/Top
Individual
Pipettes
Individual - Total Qty Needed
Plain Red Top
Individual - Total Qty Needed
Pour off transfer tubes with tops
Individual - Total Qty Needed
SST(Red & Yellow)
Individual - Total Qty Needed
Quantiferon TB Test Tubes
Individual - Total Qty Needed

NEEDLES & HOLDERS
21x1¼ Needle w/ Pre-Attached Holder
100 per box
21g Safety Lock Butterfly
50 per box
23g Safety Lock Butterfly
50 per box
25g Safety Lock Butterfly
50 per box
21g Eclipse Straight Needle
100 per box
22g Eclipse Straight Needle
100 per box
Needle Holders
50 per box

REQUISITIONS
Clinical Requisitions
Individual
Cytology/Pathology Requisitions
Individual

PAPER / PPE / SHIPPING LABELS / FROZEN PACKS
4Medica Paper
250 per pack
White Copy Paper
500 per pack
Yellow Result Paper
500 per pack
Facemasks
50 per box
FedEx Shipping Labels
Individual
FedEx Clinical Pak
Individual
Frozen Packs
Individual

BARCODE PRINTER LABELS (FOR TUBES)

PLEASE CONFIRM WHICH BARCODE PRINTER YOU HAVE BY THE PICTURES BELOW.

THERE ARE DIFFERENT LABLES FOR EACH OF THESE PRINTERS.

iDPRT Barcode Printer

Dymo LabelWriter 450

Dymo LabelWriter 550

IDPRT Barcode Printer Labels
Individual (500 per roll)
Dymo Barcode 450 Labels
Individual (500 per roll)
Dymo Barcode 550 Labels
Individual (500 per roll)

TOXICOLOGY SUPPLIES
UDS Temp Strip Cup w/ Tube
UDS Temp Cup - Regular
ETG Panel
5 Panel Urine Test
6 Panel Urine Test
Fentanyl Dips
Individual
Quantisal Oral Swabs
Individual
Toxicology Requisitions
Individual

PRINTER TONERS & DRUMS
Biotech has now partnered with Toshiba Business Sulotions for Toner and Drum Replenisment. Your Biotech printer should have either a QR code for ordering, or a phone # to call toshiba and place a supply order. If your printer has neither, or you have questions, please contact IT at 248-912-1700.

Thank you.

Additional Supplies / Comments:
Please verify that you are human*
MonthDayYear
Date
Hour MinutesAM/PM Option
hCG Urine Pregnancy
Should be Empty: