Alpha Laboratories Supply Requisition
Physician’s Name
Clinic Phone #
Date of Order
/
Month
/
Day
Year
Date
Clinic Address
Name of Person Ordering
Vacutainer Tubes
6ml Dark Blue Plain Tube (each)
6ml Dark blue with EDTA (each)
10ml Green with Heparin (each)
10ml Red Plain (100/box)
8.5ml SST (100/box)
4ml Lavender (100/box)
4.5ml Blue (each)
Collection Kits
Collection Kits
Culture Swab - Charcoal (50/pkg) - for Bacteria
Virus S. W. Kit (each) - for Viruses
Blood Culture Bottles (each)
Stool O&P Kit (each)
Stool Culture Kit (each)
Occult Blood (Not-CCC) Kits (each)
Pinworm Kit (each)
Fungus Kit (each)
Multi-Sample Needles
21G x 1 1/4" Needles (100/box)
22G x 1 1/4" Needles (100/box)
Urine Collection
90ml Urine Bottles (100/bag) - Orange Cup Urine Bottles
Bag for Urine Bottles (100/pkg)
Antiseptics Towellettes (100/box)
24 hour Urine Container (each)
Urine Separation Tube w/o Preservative (each)
Urine Separation Tube w/ Preservative (each)
Pediatric Urine Collectors (10/box)
Cytology & Histology
Formalin Biopsy Bottle (each)
PAP Liquid Based Collection Vial with Broom (each) - Pap Smears
Bandages / Wipes
Alcohol Preparation Pads (200/box)
Bandaids (100/box)
Cotton Balls (2000/bag)
Misc Supplies
Sharp's container - 5L (each)
Needle Holder (each)
Specimen Ziplock Bags (100/pkg)
Glucodex - 50g (each)
Glucodex - 75g (each)
Touriquet (each)
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