Post on 04-Jun-2018
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12 X 18
LONG TERM CARE BAG
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PK
BX
BX
BX
CASE
EA
EA
EA
EA
EA
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C) KIT
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
ACCOUNT NAME ACCT. NO. ROUTE
DATE RECEIVEDRECEIVED BY (CLIENT SIGNATURE)
BLOOD COLLECTION TUBES
GLUCOSE TOL. BEVERAGE
BAGS
MISCELLANEOUS
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
CYTO / HISTO / HPV SUPPLIES
SHARPS CONTAINERS
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197925
48197923
36996023CA
36996023CA
36996023CA
SUPPLY ORDER
RETURN THE TOP 3 COPIES TO DMC UNIVERSITY LABORATORIES326430EC (4/06)
MIDSTREAM KIT(UA AND CULTURE TUBE)MIDSTREAM KIT(UA TUBE ONLY)
MICROBIOLOGY SUPPLIES
FOR ITEMS NOT LISTED ON THE SUPPLY ORDER FORM, PLEASE CONTACT YOUR SALES REPRESENTATIVE FOR AVAILABILITY.
PLEASE ALLOW 5-7 DAYS FOR DELIVERY
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
ORDER DATE FILL DATE
BY: BY:
SPECIMEN CONTAINERS
FORMALIN BIOPSY BOTTLESSIZE: 20ML
PEDIATRIC TUBES
TOXICOLOGY SUPPLIES
LABELS
URINE-STERILE, 4OZ. (HANDI-PAK)
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
4201 St. Antoine, Detroit MI, 48201-2194
PINK TOP 6ML - K2EDTA(BLOOD BANK)
REQUISITIONS AND FORMS
EA
EA
EA
36812056CA
36812070CA
36812007CA
LARGE
MEDIUM
WALL MOUNT (SMALL)
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
THIN PREP VIALSCYTOBRUSHES & SPATULAS
REVIEWED BY DATE
REQUEST REQUEST PRODUCTNUMBER ISSUEDUNITISSUEDPRODUCT
NUMBERUNITISSUEDPRODUCTNUMBERUNITREQUEST
ROYAL BLUE TOP 7ML-NO ADDITIVE
ORDERS ARE FILLED BASED ON PREVIOUS TEST VOLUMES AND SUPPLY REQUESTS
BLOOD CULTURE VIALANAEROBIC
BLOOD CULTURE VIALAEROBIC
CHLAMYDIA/GC AMP PROBETEC - FEMALECHLAMYDIA/GC AMP PROBETEC - MALECHLAMYDIA CULTUREFLEX TRANS
DIAMONDS MEDIA(TRICHOMONAS)ENTERIC TRANS MEDIA(STOOL CULTURE)
MYCOPLASMA TRANSPORTMEDIUM
VIRAL TRANSPORT(HERPES CULTURE)
COAGULATION TEST
CYTOGENETICS TEST
CYTOLOGY/HISTOLOGY TEST
ESOTERIC TEST
LONG TERM CARE TEST
ROUTINE TEST
TOXICOLOGY TEST
LARGE
MEDIUM
WALL MOUNT (SMALL)
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12x18
LONG TERM CARE BAGS
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
36812056CA
36812070CA
36812007CA
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
1
1
1
1
1
1
1
1
50
50
50
100
100
1
1
200
72
1
200
1
1
1
1
1
200
PRODUCTNUMBER UNIT Q/UNIT
1
5
5
12
12
12
12
12
4
4
4
1
2
1
1
1
2
10
1
2
1
2
2
1
1
LIMIT
CHLAMYDIA/GC AMPPROBETEC - MALE
CHLAMYDIA/GC AMPPROBETEC - FEMALE
PRODUCTNUMBER UNIT Q/UNIT LIMIT
1
1
1
100
100
1
50
1
1
20
1
1
1
1
50
1
50
50
25
100
100
1
1
1
1
20
24
25
100
100
50
50
100
1
1
1
1
1
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PKG
BX
BX
BX
CASE
EA
EA
EA
EA
EA
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197923
48197925
36996023CA
36996023CA
36996023CA
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
PRODUCTNUMBER UNIT Q/UNIT LIMIT
4
4
4
4
2
4
25
4
10
10
4
4
4
2
2
2
2
2
2
1
1
4
4
4
2
4
25
2
1
1
5
1
20
5
100
100
100
100
100
100
1
100
1
1
100
100
100
100
100
100
100
100
100
50
50
48
48
200
100
50
1
250
250
100
100
1000
1
20
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
MYCOPLASMA TRANSPORTMEDIUM
20
10
10
1
1
20
4
24
10
1
20
10
10
10
1
20
2
1
4
2
1
1
24
24
20
20
5
4
4
1
2
1
4
4
2
20
10
6
6
6
ROUTINE TEST
CYTOLOGY/HISTOLOGY TEST
COAGULATION TEST
CYTOGENETICS TEST
ESOTERIC TEST
TOXICOLOGY TEST
LONG TERM CARE TEST
URINE-STERILE, 4OZ. (HANDI-PAK)
DIAMONDS MEDIA(TRICHOMONAS)
BLOOD CULTURE VIALANAEROBIC
ENTERIC TRANS MEDIA(STOOL CULTURE)
MIDSTREAM KIT(UA TUBE ONLY)
MIDSTREAM KIT(UA AND CULTURE TUBE)
FORMALIN BIOPSY BOTTLESSIZE: 20ML
BLOOD CULTURE VIALAEROBIC
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
CHLAMYDIA CULTUREFLEX TRANS
THIN PREP VIALS, CYTOBRUSHES& SPATULAS
ROYAL BLUE TOP 7ML-NO ADDITIVES
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C.) KIT
PINK TOP 6ML - K2EDTA(PINK TUBE)
TOXICOLOGY SUPPLIES
MISCELLANEOUS
SPECIMEN CONTAINERS
LABELS
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
CYTO / HISTO / HPV SUPPLIESBAGS
GLUCOSE TOL. BEVERAGEPEDIATRIC TUBES
BLOOD COLLECTION TUBES MICROBIOLOGY SUPPLIES SHARPS CONTAINERS
REQUISITIONS AND FORMS
VIRAL TRANSPORT(HERPES CULTURE)
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12 X 18
LONG TERM CARE BAG
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PK
BX
BX
BX
CASE
EA
EA
EA
EA
EA
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C) KIT
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
ACCOUNT NAME ACCT. NO. ROUTE
DATE RECEIVEDRECEIVED BY (CLIENT SIGNATURE)
BLOOD COLLECTION TUBES
GLUCOSE TOL. BEVERAGE
BAGS
MISCELLANEOUS
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
CYTO / HISTO / HPV SUPPLIES
SHARPS CONTAINERS
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197925
48197923
36996023CA
36996023CA
36996023CA
SUPPLY ORDER
RETURN THE TOP 3 COPIES TO DMC UNIVERSITY LABORATORIES326430EC (4/06)
MIDSTREAM KIT(UA AND CULTURE TUBE)MIDSTREAM KIT(UA TUBE ONLY)
MICROBIOLOGY SUPPLIES
FOR ITEMS NOT LISTED ON THE SUPPLY ORDER FORM, PLEASE CONTACT YOUR SALES REPRESENTATIVE FOR AVAILABILITY.
PLEASE ALLOW 5-7 DAYS FOR DELIVERY
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
ORDER DATE FILL DATE
BY: BY:
SPECIMEN CONTAINERS
FORMALIN BIOPSY BOTTLESSIZE: 20ML
PEDIATRIC TUBES
TOXICOLOGY SUPPLIES
LABELS
URINE-STERILE, 4OZ. (HANDI-PAK)
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
4201 St. Antoine, Detroit MI, 48201-2194
PINK TOP 6ML - K2EDTA(BLOOD BANK)
REQUISITIONS AND FORMS
EA
EA
EA
36812056CA
36812070CA
36812007CA
LARGE
MEDIUM
WALL MOUNT (SMALL)
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
THIN PREP VIALSCYTOBRUSHES & SPATULAS
REVIEWED BY DATE
REQUEST REQUEST PRODUCTNUMBER ISSUEDUNITISSUEDPRODUCT
NUMBERUNITISSUEDPRODUCTNUMBERUNITREQUEST
ROYAL BLUE TOP 7ML-NO ADDITIVE
ORDERS ARE FILLED BASED ON PREVIOUS TEST VOLUMES AND SUPPLY REQUESTS
BLOOD CULTURE VIALANAEROBIC
BLOOD CULTURE VIALAEROBIC
CHLAMYDIA/GC AMP PROBETEC - FEMALECHLAMYDIA/GC AMP PROBETEC - MALECHLAMYDIA CULTUREFLEX TRANS
DIAMONDS MEDIA(TRICHOMONAS)ENTERIC TRANS MEDIA(STOOL CULTURE)
MYCOPLASMA TRANSPORTMEDIUM
VIRAL TRANSPORT(HERPES CULTURE)
COAGULATION TEST
CYTOGENETICS TEST
CYTOLOGY/HISTOLOGY TEST
ESOTERIC TEST
LONG TERM CARE TEST
ROUTINE TEST
TOXICOLOGY TEST
LARGE
MEDIUM
WALL MOUNT (SMALL)
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12x18
LONG TERM CARE BAGS
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
36812056CA
36812070CA
36812007CA
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
1
1
1
1
1
1
1
1
50
50
50
100
100
1
1
200
72
1
200
1
1
1
1
1
200
PRODUCTNUMBER UNIT Q/UNIT
1
5
5
12
12
12
12
12
4
4
4
1
2
1
1
1
2
10
1
2
1
2
2
1
1
LIMIT
CHLAMYDIA/GC AMPPROBETEC - MALE
CHLAMYDIA/GC AMPPROBETEC - FEMALE
PRODUCTNUMBER UNIT Q/UNIT LIMIT
1
1
1
100
100
1
50
1
1
20
1
1
1
1
50
1
50
50
25
100
100
1
1
1
1
20
24
25
100
100
50
50
100
1
1
1
1
1
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PKG
BX
BX
BX
CASE
EA
EA
EA
EA
EA
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197923
48197925
36996023CA
36996023CA
36996023CA
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
PRODUCTNUMBER UNIT Q/UNIT LIMIT
4
4
4
4
2
4
25
4
10
10
4
4
4
2
2
2
2
2
2
1
1
4
4
4
2
4
25
2
1
1
5
1
20
5
100
100
100
100
100
100
1
100
1
1
100
100
100
100
100
100
100
100
100
50
50
48
48
200
100
50
1
250
250
100
100
1000
1
20
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
MYCOPLASMA TRANSPORTMEDIUM
20
10
10
1
1
20
4
24
10
1
20
10
10
10
1
20
2
1
4
2
1
1
24
24
20
20
5
4
4
1
2
1
4
4
2
20
10
6
6
6
ROUTINE TEST
CYTOLOGY/HISTOLOGY TEST
COAGULATION TEST
CYTOGENETICS TEST
ESOTERIC TEST
TOXICOLOGY TEST
LONG TERM CARE TEST
URINE-STERILE, 4OZ. (HANDI-PAK)
DIAMONDS MEDIA(TRICHOMONAS)
BLOOD CULTURE VIALANAEROBIC
ENTERIC TRANS MEDIA(STOOL CULTURE)
MIDSTREAM KIT(UA TUBE ONLY)
MIDSTREAM KIT(UA AND CULTURE TUBE)
FORMALIN BIOPSY BOTTLESSIZE: 20ML
BLOOD CULTURE VIALAEROBIC
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
CHLAMYDIA CULTUREFLEX TRANS
THIN PREP VIALS, CYTOBRUSHES& SPATULAS
ROYAL BLUE TOP 7ML-NO ADDITIVES
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C.) KIT
PINK TOP 6ML - K2EDTA(PINK TUBE)
TOXICOLOGY SUPPLIES
MISCELLANEOUS
SPECIMEN CONTAINERS
LABELS
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
CYTO / HISTO / HPV SUPPLIESBAGS
GLUCOSE TOL. BEVERAGEPEDIATRIC TUBES
BLOOD COLLECTION TUBES MICROBIOLOGY SUPPLIES SHARPS CONTAINERS
REQUISITIONS AND FORMS
VIRAL TRANSPORT(HERPES CULTURE)
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12 X 18
LONG TERM CARE BAG
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PK
BX
BX
BX
CASE
EA
EA
EA
EA
EA
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C) KIT
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
ACCOUNT NAME ACCT. NO. ROUTE
DATE RECEIVEDRECEIVED BY (CLIENT SIGNATURE)
BLOOD COLLECTION TUBES
GLUCOSE TOL. BEVERAGE
BAGS
MISCELLANEOUS
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
CYTO / HISTO / HPV SUPPLIES
SHARPS CONTAINERS
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197925
48197923
36996023CA
36996023CA
36996023CA
SUPPLY ORDER
RETURN THE TOP 3 COPIES TO DMC UNIVERSITY LABORATORIES326430EC (4/06)
MIDSTREAM KIT(UA AND CULTURE TUBE)MIDSTREAM KIT(UA TUBE ONLY)
MICROBIOLOGY SUPPLIES
FOR ITEMS NOT LISTED ON THE SUPPLY ORDER FORM, PLEASE CONTACT YOUR SALES REPRESENTATIVE FOR AVAILABILITY.
PLEASE ALLOW 5-7 DAYS FOR DELIVERY
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
ORDER DATE FILL DATE
BY: BY:
SPECIMEN CONTAINERS
FORMALIN BIOPSY BOTTLESSIZE: 20ML
PEDIATRIC TUBES
TOXICOLOGY SUPPLIES
LABELS
URINE-STERILE, 4OZ. (HANDI-PAK)
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
4201 St. Antoine, Detroit MI, 48201-2194
PINK TOP 6ML - K2EDTA(BLOOD BANK)
REQUISITIONS AND FORMS
EA
EA
EA
36812056CA
36812070CA
36812007CA
LARGE
MEDIUM
WALL MOUNT (SMALL)
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
THIN PREP VIALSCYTOBRUSHES & SPATULAS
REVIEWED BY DATE
REQUEST REQUEST PRODUCTNUMBER ISSUEDUNITISSUEDPRODUCT
NUMBERUNITISSUEDPRODUCTNUMBERUNITREQUEST
ROYAL BLUE TOP 7ML-NO ADDITIVE
ORDERS ARE FILLED BASED ON PREVIOUS TEST VOLUMES AND SUPPLY REQUESTS
BLOOD CULTURE VIALANAEROBIC
BLOOD CULTURE VIALAEROBIC
CHLAMYDIA/GC AMP PROBETEC - FEMALECHLAMYDIA/GC AMP PROBETEC - MALECHLAMYDIA CULTUREFLEX TRANS
DIAMONDS MEDIA(TRICHOMONAS)ENTERIC TRANS MEDIA(STOOL CULTURE)
MYCOPLASMA TRANSPORTMEDIUM
VIRAL TRANSPORT(HERPES CULTURE)
COAGULATION TEST
CYTOGENETICS TEST
CYTOLOGY/HISTOLOGY TEST
ESOTERIC TEST
LONG TERM CARE TEST
ROUTINE TEST
TOXICOLOGY TEST
LARGE
MEDIUM
WALL MOUNT (SMALL)
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12x18
LONG TERM CARE BAGS
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
36812056CA
36812070CA
36812007CA
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
1
1
1
1
1
1
1
1
50
50
50
100
100
1
1
200
72
1
200
1
1
1
1
1
200
PRODUCTNUMBER UNIT Q/UNIT
1
5
5
12
12
12
12
12
4
4
4
1
2
1
1
1
2
10
1
2
1
2
2
1
1
LIMIT
CHLAMYDIA/GC AMPPROBETEC - MALE
CHLAMYDIA/GC AMPPROBETEC - FEMALE
PRODUCTNUMBER UNIT Q/UNIT LIMIT
1
1
1
100
100
1
50
1
1
20
1
1
1
1
50
1
50
50
25
100
100
1
1
1
1
20
24
25
100
100
50
50
100
1
1
1
1
1
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PKG
BX
BX
BX
CASE
EA
EA
EA
EA
EA
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197923
48197925
36996023CA
36996023CA
36996023CA
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
PRODUCTNUMBER UNIT Q/UNIT LIMIT
4
4
4
4
2
4
25
4
10
10
4
4
4
2
2
2
2
2
2
1
1
4
4
4
2
4
25
2
1
1
5
1
20
5
100
100
100
100
100
100
1
100
1
1
100
100
100
100
100
100
100
100
100
50
50
48
48
200
100
50
1
250
250
100
100
1000
1
20
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
MYCOPLASMA TRANSPORTMEDIUM
20
10
10
1
1
20
4
24
10
1
20
10
10
10
1
20
2
1
4
2
1
1
24
24
20
20
5
4
4
1
2
1
4
4
2
20
10
6
6
6
ROUTINE TEST
CYTOLOGY/HISTOLOGY TEST
COAGULATION TEST
CYTOGENETICS TEST
ESOTERIC TEST
TOXICOLOGY TEST
LONG TERM CARE TEST
URINE-STERILE, 4OZ. (HANDI-PAK)
DIAMONDS MEDIA(TRICHOMONAS)
BLOOD CULTURE VIALANAEROBIC
ENTERIC TRANS MEDIA(STOOL CULTURE)
MIDSTREAM KIT(UA TUBE ONLY)
MIDSTREAM KIT(UA AND CULTURE TUBE)
FORMALIN BIOPSY BOTTLESSIZE: 20ML
BLOOD CULTURE VIALAEROBIC
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
CHLAMYDIA CULTUREFLEX TRANS
THIN PREP VIALS, CYTOBRUSHES& SPATULAS
ROYAL BLUE TOP 7ML-NO ADDITIVES
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C.) KIT
PINK TOP 6ML - K2EDTA(PINK TUBE)
TOXICOLOGY SUPPLIES
MISCELLANEOUS
SPECIMEN CONTAINERS
LABELS
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
CYTO / HISTO / HPV SUPPLIESBAGS
GLUCOSE TOL. BEVERAGEPEDIATRIC TUBES
BLOOD COLLECTION TUBES MICROBIOLOGY SUPPLIES SHARPS CONTAINERS
REQUISITIONS AND FORMS
VIRAL TRANSPORT(HERPES CULTURE)
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12 X 18
LONG TERM CARE BAG
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PK
BX
BX
BX
CASE
EA
EA
EA
EA
EA
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C) KIT
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
ACCOUNT NAME ACCT. NO. ROUTE
DATE RECEIVEDRECEIVED BY (CLIENT SIGNATURE)
BLOOD COLLECTION TUBES
GLUCOSE TOL. BEVERAGE
BAGS
MISCELLANEOUS
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
CYTO / HISTO / HPV SUPPLIES
SHARPS CONTAINERS
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197925
48197923
36996023CA
36996023CA
36996023CA
SUPPLY ORDER
RETURN THE TOP 3 COPIES TO DMC UNIVERSITY LABORATORIES326430EC (4/06)
MIDSTREAM KIT(UA AND CULTURE TUBE)MIDSTREAM KIT(UA TUBE ONLY)
MICROBIOLOGY SUPPLIES
FOR ITEMS NOT LISTED ON THE SUPPLY ORDER FORM, PLEASE CONTACT YOUR SALES REPRESENTATIVE FOR AVAILABILITY.
PLEASE ALLOW 5-7 DAYS FOR DELIVERY
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
ORDER DATE FILL DATE
BY: BY:
SPECIMEN CONTAINERS
FORMALIN BIOPSY BOTTLESSIZE: 20ML
PEDIATRIC TUBES
TOXICOLOGY SUPPLIES
LABELS
URINE-STERILE, 4OZ. (HANDI-PAK)
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
4201 St. Antoine, Detroit MI, 48201-2194
PINK TOP 6ML - K2EDTA(BLOOD BANK)
REQUISITIONS AND FORMS
EA
EA
EA
36812056CA
36812070CA
36812007CA
LARGE
MEDIUM
WALL MOUNT (SMALL)
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
THIN PREP VIALSCYTOBRUSHES & SPATULAS
REVIEWED BY DATE
REQUEST REQUEST PRODUCTNUMBER ISSUEDUNITISSUEDPRODUCT
NUMBERUNITISSUEDPRODUCTNUMBERUNITREQUEST
ROYAL BLUE TOP 7ML-NO ADDITIVE
ORDERS ARE FILLED BASED ON PREVIOUS TEST VOLUMES AND SUPPLY REQUESTS
BLOOD CULTURE VIALANAEROBIC
BLOOD CULTURE VIALAEROBIC
CHLAMYDIA/GC AMP PROBETEC - FEMALECHLAMYDIA/GC AMP PROBETEC - MALECHLAMYDIA CULTUREFLEX TRANS
DIAMONDS MEDIA(TRICHOMONAS)ENTERIC TRANS MEDIA(STOOL CULTURE)
MYCOPLASMA TRANSPORTMEDIUM
VIRAL TRANSPORT(HERPES CULTURE)
COAGULATION TEST
CYTOGENETICS TEST
CYTOLOGY/HISTOLOGY TEST
ESOTERIC TEST
LONG TERM CARE TEST
ROUTINE TEST
TOXICOLOGY TEST
LARGE
MEDIUM
WALL MOUNT (SMALL)
MOLECULAR GENETICS
SUPPLY ORDER FORM
COLA, 100 gm
LEMON LIME, 100 gm
ORANGE, 100 gm
ORANGE, 75 gm
ORANGE, 50 gm
DMCUL BAG 12x18
LONG TERM CARE BAGS
SPECIMEN TRANSPORT BAG
ANTISEPTIC TOWELETTES
AUTODIAL RESULT PAPER 1 PART
AUTODIAL PRINTER RIBBON
CENTRIFUGE
COTTON BALLS
FROSTED END SLIDES
ICE TRANSPORT
4MEDICA LABEL PAPER
4MEDICA RESULT PAPER
4MEDICA PRINTER CARTRIDGE(SPECIFY MODEL)
PATIENT LOG BOOK
PHONE REPORT PAD
SPECIMEN LOCK BOX
SPONGES 2X2
36812056CA
36812070CA
36812007CA
322560FRCT
322560FQCA
322560FBCA
322570XGPK
326430UXCA
326430ZG
326430DVCA
326430ECCA
322560FJBX
23210003CA
23210002CA
23210001CA
23210007EA
23210006EAX
36811472CA
36811471CA
48197954CA
48194743CA
322560F4CA
48490017EA
48194709CA
37137203CA
369946APCAX
321971JA
32237312EA
326430EDPD
481930BYCA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
PKG
PKG
PKG
BX
CASE
EA
EA
PKG
BX
EA
CASE
PKG
EA
EA
EA
EA
PKG
1
1
1
1
1
1
1
1
50
50
50
100
100
1
1
200
72
1
200
1
1
1
1
1
200
PRODUCTNUMBER UNIT Q/UNIT
1
5
5
12
12
12
12
12
4
4
4
1
2
1
1
1
2
10
1
2
1
2
2
1
1
LIMIT
CHLAMYDIA/GC AMPPROBETEC - MALE
CHLAMYDIA/GC AMPPROBETEC - FEMALE
PRODUCTNUMBER UNIT Q/UNIT LIMIT
1
1
1
100
100
1
50
1
1
20
1
1
1
1
50
1
50
50
25
100
100
1
1
1
1
20
24
25
100
100
50
50
100
1
1
1
1
1
EA
EA
EA
BX
BX
EA
PKG
EA
EA
BX
EA
EA
EA
EA
BX
EA
PKG
PKG
PKG
EA
BX
EA
EA
EA
EA
BX
PKG
BX
PKG
BX
BX
BX
CASE
EA
EA
EA
EA
EA
369960LGCA
37138328PK
36342006PK
481947A1CA
481947A2CA
484650CWPK
363420DHBX
363420CJPK
36342063PK
363420A1PK
484900BVPK
363450Z1BX
363420CGPK
37137239CAX
48156607CA
363420EQPK
481581E5BG
38977111PK
38977106CA
48341655CA
48197109CA
34582207CAX
358830AGCA
369960LCCA
37137237CA
481376EP
3634511PCA
369960BLBG
36996076CA
36996008CA
36997709CA
36996005CA
48197923
48197925
36996023CA
36996023CA
36996023CA
ANAEROBIC TUBE & VIAL
CULTURE SWAB
G.C. JEMBEC PLATES
HEMOCCULT W/O DEVELOPER
HERPES I & II DIRECT
OVA & PARASITE (PARAPAK)
URINE CULTURE TRANSPORT
CERVICAL SPATULA-MILEX
CYTOLOGY BROOMS 8''
CYTOLOGY BRUSHES 6"
CYTOLOGY FIXATIVE
POLYESTER SWAB
HPV TRANSPORT MEDIA
PAP SMEAR KIT 1 SLIDE
SLIDE HOLDERS
BLOOD TRANSFER TUBE
MIDSTREAM KIT (NO TUBES)
STERILE UA CUP, 4 OZ.
U BAG NEWBORN
U BAG PEDIATRIC
URINE-BORIC ACID, 24 HR.
URINE-HCL 6N, 24 HR.
URINE-PLAIN, 24 HR.
PRODUCTNUMBER UNIT Q/UNIT LIMIT
4
4
4
4
2
4
25
4
10
10
4
4
4
2
2
2
2
2
2
1
1
4
4
4
2
4
25
2
1
1
5
1
20
5
100
100
100
100
100
100
1
100
1
1
100
100
100
100
100
100
100
100
100
50
50
48
48
200
100
50
1
250
250
100
100
1000
1
20
BX
BX
BX
BX
BX
BX
EA
BX
EA
EA
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
BX
EA
BAG
RL
RL
RL
RL
EA
BX
48156639CA
369960ADBX
48156633CA
48156654CA
481566C1
48156638CA
481566B1BX
48156630CA
369960H6BX
369960H5BX
481566AJCA
48156620
48156641CA
48156640CA
36998511CA
48156636CA
48156638CA
48156632CA
48156622CA
48167445CA
48167485CA
48188264BX
48188278CA
48194730CA
48193486BX
48193457CA
36678140PK
48156649CA
321971APPK
321971B5RL
321971ACRL
321971AHRL
36997710CAX
36996075CA
MYCOPLASMA TRANSPORTMEDIUM
20
10
10
1
1
20
4
24
10
1
20
10
10
10
1
20
2
1
4
2
1
1
24
24
20
20
5
4
4
1
2
1
4
4
2
20
10
6
6
6
ROUTINE TEST
CYTOLOGY/HISTOLOGY TEST
COAGULATION TEST
CYTOGENETICS TEST
ESOTERIC TEST
TOXICOLOGY TEST
LONG TERM CARE TEST
URINE-STERILE, 4OZ. (HANDI-PAK)
DIAMONDS MEDIA(TRICHOMONAS)
BLOOD CULTURE VIALANAEROBIC
ENTERIC TRANS MEDIA(STOOL CULTURE)
MIDSTREAM KIT(UA TUBE ONLY)
MIDSTREAM KIT(UA AND CULTURE TUBE)
FORMALIN BIOPSY BOTTLESSIZE: 20ML
BLOOD CULTURE VIALAEROBIC
FORMALIN BIOPSY BOTTLESSIZE: 40MLFORMALIN BIOPSY BOTTLESSIZE: 90ML
CHLAMYDIA CULTUREFLEX TRANS
THIN PREP VIALS, CYTOBRUSHES& SPATULAS
ROYAL BLUE TOP 7ML-NO ADDITIVES
GRAY TOP 6ML
GREEN TOP 7ML-LITHIUM HEPARIN
GREEN TOP 10ML-SODIUM HEPARIN
LAVENDER TOP 4ML
POWDER BLUE TOP 2.7ML
PPT TUBES (HIV VIRAL LOAD)
RED TOP 10ML (PLAIN)
ROYAL BLUE TOP 7ML-EDTA
SERUM SST 8.5ML
SERUM SST GOLD TOP 5.0ML
YELLOW ACD "B" TUBES
GRAY TOP 2ML
GREEN 3ML-LITHIUM HEPARIN
LAVENDER TOP 3ML
POWDER BLUE TOP 2.7ML
RED TOP 3ML (PLAIN)
SERUM SEPARATION 4ML
BUTTERFLY 23Gx¾" 12" TUBING
BUTTERFLY 21G x ¾" 12" TUBING
MULTISAMPLE 21G 1¼"
MULTISAMPLE 22G 1¼"
ALCOHOL SWABS
BANDAIDS-REGULAR
BANDAIDS-SPOTS
TOURNIQUETS
VACUTAINER HOLDER
FROZEN
PAI LABEL NEW / CHANGE
SPECIMEN
STAT
UDS (C.O.C.) KIT
PINK TOP 6ML - K2EDTA(PINK TUBE)
TOXICOLOGY SUPPLIES
MISCELLANEOUS
SPECIMEN CONTAINERS
LABELS
BLOOD COLLECTION SUPPLIES
BLOOD COLLECTION NEEDLES
CYTO / HISTO / HPV SUPPLIESBAGS
GLUCOSE TOL. BEVERAGEPEDIATRIC TUBES
BLOOD COLLECTION TUBES MICROBIOLOGY SUPPLIES SHARPS CONTAINERS
REQUISITIONS AND FORMS
VIRAL TRANSPORT(HERPES CULTURE)