AMA Supplies

ITEMS MARKED WITH * ARE REQUIRED

SUPPLY ORDER FORM

Account # *	Client Name: *
	Ordered By: *

SUPPLY ITEMS

FORMS	QTY	CODE	CYTOLOGY/HISTOLOGY	QTY	CODE
Standard Lab Test Requisition			PAP Pak's (One Slide)
Cytology/Histology Requisition			Fixative Spray
Family Pact Requisition			Viral PAP (HPV)
Combo Requisition (Standard/Family Pact)			Sure Path (Brushes) Blue Top
Free Form Requisition			Thin Prep (Spatula/Brushes) White Top
Chain of Custody Requisition			Biopsy Containers Small 12ml
Lab Report One Part Laser			Biopsy Containers Medium 30ml
Supply Order Form			MICROBIOLOGY
NEEDLES			Blood Culture Bottles
21x1-1/4"			Blood Culture Bottles Pediatric
22x1-1/4"			Transport Med (Herpes Media)
Needle Holder (Single Use)			GC/Chlamydia Kit Female
Lancettes			GC/Chlamydia Kit Male
VACUTAINERS			Stool Parasite Kit (Para-Pak)
SST 8.5mL Serum Separator			Wet Mount Saline
SST 4mL Serum Separator			Hemocult Slide
Lavender 4mL EDTA			CULTURETTES
Light Blue 4.5mL (Glass)			Routine (Throat, Eye, Vaginal)
Gray 4mL			URINE COLLECTION & TRANSPORT
Red 5mL (No Serum Separator)			Collection Cup (Sterile)
Green 10mL			24 HOUR URINE COLLECTION BAGS
Yellow 10mL			With HCL
Pink 6mL			With Boric Acid
Dark Blue (Trace Element K2 EDTA)6mL			With no Preservatives
PPT 5mL			GLUCOSE TOLERANCE BEVERAGE 50gms
PEDIATRIC TUBES			Orange
Red 4mL			Punch
Blue 2.7mL			Lime
Lavendar 3mL			GLUCOSE TOLERANCE BEVERAGE 100gms
Gray 2mL			Orange
MICROTAINERS			Punch
Lavender			Lime
Red SST			OTHERS
			OB Towelettes
			Transport Vials 6mL Frozen
			Specimen Bags

Additional Requests

CHECK BOX Please have my Field Service Representative contact me.

Please allow 2 working days for delivery.

Advanced Medical Analysis, LLC. 1941 Walker Ave. Monrovia, CA 91016

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