Supply Reorder CLIENT SUPPLY ORDER FORM Date Ordered Physician/Clinic Address City/State/ZIP Northwest Arkansas Pathology provides free of charge supplies that the client requires to collect specimens to be sent to Northwest Arkansas Pathology for analysis. Please indicate those supplies you need. QUANTITY NEEDED Containers 10 ml prefilled formalin containers box 30 ml prefilled formalin containers box 60 ml prefilled formalin containers box 120 ml prefilled formalin containers box 240 ml prefilled formalin containers box 10% buffered formalin cube 10% buffered formalin gal 32oz white plastic containers w/lids box 64oz white plastic containers w/lids box 86oz white plastic containers w/lids box 172oz white plastic containers w/lids box BAGS(Specimen Transport) 8 x 10 biohazard bags pkg 6 x 9 biohazard bags pkg 12 x 14 biohazard bags pkg Labels Formaldehyde warning labels pkg Specimen ID pkg Non-Gyn Saccomanno fluid tray 20ml flip top containers box Cytology Pap Perfect Cytopak Kit with brush and scraper box Frosted end slides gross Cervical scraper with endocervical brush pkg Papette cervical broom pkg Cytologic fixative (Aqua-Net®) can Preserve-Cyt® THIN PREP vials flat Preserve-Cyt® THIN PREP vials case Molecular Pathology Collection Kits GenProbe APTIMA Urine Specimens box GenProbe APTIMA Swab Specimens box Requisitions Surgical requisitions / 50 Pap smear (Cytology and Molecular Pathology) requisitions / 50 Non-Gyn requisitions / 50 Miscellaneous Client Supply order forms / 25 Plastic slide holders gross Δ
