LifeLabs Supply Order Form
Client ID (Doctor OHIP Billing # or Lifelabs Client ID)
Client Name
Date
/
Month
/
Day
Year
Date
Address
Please select the closest LifeLabs area
Please Select
LS02A - GTA
LS02B - North (Newmarket)
LS02C - London
LS02D - KW Area
LS02E - Niagara Area
LS02F - Barrie
LS02G - Orillia
LS02H - Belleville Area
LS02I - Ottawa Area
LS02J - Kingston Area
LS02K - Sudbury Area
LS02L - Thunder Bay
Phone #
Client Office Contact Name
Microbiology
Culture Swab Transport System – Charcoal (Bag-50) - Bacterial
APTIMA Multitest Collection Kit (Vaginal/Throat/Rectal) SWAB (Each) - Viral
APTIMA Unisex (Endocervical/Urethral) SWAB (Each)
Fungus Scraping Kit (Each)
Stool Culture & Sensitivity (C&S) Kit (Each)
Stool Parasites - PCR Method (Parasite Swab) (Each)
Stool Parasites – SAF Fixative (Each)
Pinworm Kit (Each)
Sputum Culture & Sensitivity (C&S) Kit (Each)
Urine Culture & Sensitivity (C&S) Kit (Each)
Sterile 90ml Container with Orange Cap (Bag)
Collection, Urine Collection Ped. URC-010 (Box-10)
Castile Soap Towelette (Box-100)
Cytology
Pap Liquid Based Collection Vial (also for HPV testing) (Pk-25) - Pap 1/2
Pap Collection Broom (Blue) (Rover) (Pk-25) - Pap 2/2
Pap Collection / Spatula With Brush (Purple) (Surepath) (Pk-25)
HPV & Cytology Requisition (PD-25)
Fine Needle Aspiration Kit (Cytology) (Each)
Urine Collection Kit (Cytology) (Each)
Sputum Collection Kit (Cytology) (Each)
Histology
Small Biopsy 40ml Container (Histology) (Each)
Medium Biopsy 90ml Container (Histology) (Each)
6x9 Ziploc Histology Bag (Pk-100)
13x9 Ziploc Histology Bag (Pk-100)
Phlebotomy
Tube 13 x 100 Gold 5ml SST (Flat-100)
Tube 13 x 75 Lavender 4ml EDTA (Flat-100)
Tube 13 x 100 Grey 6ml Oxalate Fluoride (Each)
Tube 13 x 75 Light Blue 2.7ml Citrate (Each)
Tube 13 x 100 Plain Red 6ml (Each)
Tube 13 x 100 Royal Blue 6ml with K2EDTA (Each)
Tube 13 x 100 Plain Royal Blue 6ml (Each)
Tube 16 x 100 Yellow 8.5ml ACD (Each)
Tube 13 x 100 Green 6ml Sodium Heparin (Each)
Tube 13 x 100 Pink 6ml K2EDTA (Each)
Bottle, Bactec: Plus Peds Media, Plastic (Each)
Bottle, Bactec: Plus Anaerobic Media, Plastic (Each)
Bottle, Bactec: Plus Aerobic Media, Plastic (Each)
Needle Eclipse 22g x 1¼ (black) (Box-48)
Needle Eclipse 21g x 1¼ (green) (Box-48)
Sharps Container Yellow 2gal (Each)
Pronto Needle Holder (Each)
Alcohol Prep pad, 70% (Box-200)
Tape Surgical 3M Micro Pore (Each)
Cotton Balls Medium (Bag)
Tourniquet Strap Latex Free (Each)
Miscellaneous
Hema Screen Occult Blood (Each)
Semen Analysis Kit (Each)
Poly Bag 6 x 9 (PK)
LTC On-Site Lab Services (PK-100)
Sputum Collection Kit (Cytology) (Each)
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