request supplies

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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, Linda Piner, 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)