supply requisition...

Please note:  You must be an established MCL Client to use this order form.
If you have any problems using your Client Mnemonic, or if you do not know your Client Mnemonic, please contact the Webmaster, your Client Maintenance Representative, or notify your Courier.

You do NOT need an e-mail account to use this form!  All information will be sent directly to us using Medical Center Lab's web server.

The following items are supplied free of charge for specimens being returned to Medical Center Lab.  Please enter the quantity in the appropriate space beside the item you wish to order.   

*Client Mnemonic:

 (required)

*Requested By:

  (required)
 

Blood Drawing Supplies

Micro/Immunology Supplies
Safety Needles 21 1.5 in.

Sterile Urine Cups
Safety Needles 22 1.5 in.   Boritex Urine Cups
Tourniquets

Chlamydia/GC Kits - Male
Needle Holders

Chlamydia/GC Kits - Female
Tubes Culturettes
Pink (Blood Bank Only)   Stool C&S Kits
Lavender

Hemoccult Slides
Blue

Blood Culture (Adult Set)
Red

Blood Culture (Ped Set)
Yellow

24-Hour Urine Bottles
Transport Tubes

Drug Screen Supplies
Transport Bags

Collection Cups

Histology/Cytology Supplies

 Chain of Custody Forms
Biopsy Bottles Forms
Cytology Scrapers Clinical Requests
Frosted Slides Cytology Requests
PAP Fixative Surgical Pathology Requests
PAP Slide Marker Supply Requests
Slide Holder Other (Please be specific)
PAP Brushes
Thin Prep Bottles
Thin Prep Brooms  
Thin Prep Brushes/Scrapers  

In the box below, please enter specific  information (if any) about a particular item ordered or  any questions or comments about your order:

In case we have questions about your request,
please tell us how to get in touch with you:

E-mail: 
FAX: 

Check here if this is a RUSH order! 

Check here if this is a REVISED order!       

*Date Needed:   (Required)

*Change Order Status When Completed  (Required)