Supply Request Form

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Supply Request Form

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Attention
Histology / Tissue Specimens
10% Neutral buffered formalin (prefilled containers)
20 mL (24 each)
40 mL (24 each)
60 mL (24 each)
120 mL (24 each)
5 G
Specimen containers
4 oz (120 mL)
8 oz (240 mL)
16 oz (480 mL)
64 oz (1920 mL)
128 oz / 1 G
2.5 G pail
Michel's fixative for immunofluorescence
(Not a stock item. Will be provided on an individual basis as needed.)
Cytology Specimens
ThinPrep Pap (prefilled containers) (25 each)
ThinPrep Pap brush and spatula (25 each)
ThinPrep brooms (25 each)
ThinPrep Pap Test Quick Reference Guide
CytoLyt solution (nongynecologic specimens)
Cytology spray fixative
Aptima urine collection kit (CT/NG unisex)
Aptima unisex swab (CT/NG)
BD Affirm VPIII transport kit
BD Affirm VPIII extra swabs
BD Affirm VPIII Collection Guide
Miscellaneous
Specimen Requisitions
Gyn Pathology Requisition
Surgical Pathology Requisition
Special Studies Requisition
PCNM Collection Guidelines
Advanced Beneficiary Notices (ABN) Form - English
Advanced Beneficiary Notices (ABN) Form - Spanish
Pap ICD-10 Codes for Medicare, Medicaid, and All Insurances
Molecular ICD-10 Codes for Medicare, Medicaid, and All Insurances
Specimen transport bags
Specimen Pick-up Log
Cardboard slide mailers
Plastic slide mailers
4 x 6 x 8 boxes
4 x 12 x 12 boxes
5 x 5 x 5 boxes
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