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Order Lab Supplies
Order Lab Supplies
mkulwiec
2017-12-12T16:01:45+00:00
Lab Supply Order Form
Account Information: *(required)
Site / Account Number
Physician Name
*
Address
*
City
*
State
*
Zip
*
Phone Number
*
Email address
*
Specimen Packing Supplies:
Biohazard Medium Bag – 6 x 9 inch (Pack of 50)
0
1
2
3
4
PACK(S)
Dry Keratin Specimen Bag (Pack of 50)
0
1
2
3
4
PACK(S)
Empty Specimen Transport Box – 2 Vial
0
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3
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5
6
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9
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20
Empty Specimen Transport Box – 6 Vial
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5
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9
10
Transport Box Insert For Vials – 2 Vial
0
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9
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17
18
19
20
Transport Box Insert For Vials – 6 Vial
0
1
2
3
4
5
6
7
8
9
10
20 mL Vials – EMPTY (pack of 25)
0
1
2
3
4
60 mL Sterile Vials – EMPTY (each)
0
1
2
3
4
5
6
7
8
9
10
Formalin Vials - 20 mL (Pack of 48)
0
1
2
3
4
Collection / Transport Kit – 2 Vial
0
1
2
3
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5
6
7
8
9
10
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19
20
Includes 2 20 mL formalin containers, dry keratin bag, 6 x 6 biohazard bag.
Collection / Transport Kit – 6 Vial
0
1
2
3
4
5
6
7
8
9
10
Includes 6 20 mL formalin containers, dry keratin bag, 6 x 6 biohazard bag.
Epidermal Nerve Fiber Density Testing Kit – Single Biopsy Location
0
1
2
3
4
5
6
7
8
9
10
ENFD kits are sent with prepaid FedEx Clinical Paks and Airbills unless indicated in the Comments section below.
Epidermal Nerve Fiber Density Testing Kit – Dual Biopsy Locations
0
1
2
3
4
5
6
7
8
9
10
Epidermal Nerve Fiber Density DVD and Instructional Video
Aspiration Biopsy Kit – ETOH / Dehydrated Alcohol – 2 Vial
0
1
2
3
4
5
6
7
8
9
10
eSwabs (Order Individually) (Include swab letter)
0
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5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
Nail Unit / Keratin Analysis Kit
Contains 5 USPS Prepaid Mailers, 5 Dry Keratin Requisitions, 5 Dry Keratin Biohazard Bags.
Specimen Transport Supplies:
FedEx Clinical Pak (mailing bag)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
FedEx Prepaid Airbills
0
1
2
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4
5
6
7
8
9
10
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15
16
17
18
19
20
EACH
UPS Clinical Pak (mailing bag)
0
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8
9
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15
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19
20
EACH
UPS Prepaid Airbills
0
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7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
United States Postal Service Prepaid Dry Keratin Mailer
USPS Mailers are to be used for routine dry keratin specimens.
Forms
Podiatry Requisition Form
0
10
25
50
100
Dry Keratin Requisition Form
0
10
25
50
100
ENFD Requisition Form
0
10
25
50
100
Surgery Center & Family Practice Requisition Form
0
10
25
50
100
Dermatology Requisition Form
0
10
25
50
100
Supply Order Forms
Specimen Vial Labels (28 per sheet)
Comments
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