VICTORIA DOCTORS ORDER FORM * mandatory entry fields * Surgery/Clinic (ID please): *Your Name   Your Phone *Your Email    NEEDLES Product Code U.O.M. Qty.     Holder Needle Standard Yellow Vacutainer 364879 (33222) EACH     Needle BD Vacutainer 22g x 1.5" Black 360211 (15172) BOX     Needle Hypodermic 21g x 38mm Sterile Gr. 302017 (33236) BOX     Needle Hypodermic 23g x 32mm Sterile Blu 302008 (33239) BOX     Needle Multi Sample 21g x 38mm Green Vac 360213 (33246) BOX    SYRINGES Product Code U.O.M. Qty.     Syringe Luer Slip 10ml (Eccentric Tip) 302146 (33276) EACH     Syringe Luer Slip 5ml 302130 (33291) EACH    CONTAINERS Product Code U.O.M. Qty.     Acid Washed 24Hr.Urine 002038 (11389) EACH     Bag Specimen Clear Printed with Healthsc SB101HSC (20020) PACKET     Bag Specimen Red Printed with Healthscop SB101HSCURGENT (20021) PACKET     Container, 25ml PP White, Scoop, Hsp Lbl 80.9924.017 (20296) BAG     Container, 70ml PP Yw Cap Cln Rm Hsp Lbl 75.9922.693 (20298) BAG     Histopot Formalin Filled 250ml Healthsco AHPHSP.250ML (20300) EACH     Histopot Formalin Filled 25ml Healthscop AHPHSP.25ML (20301) PACK     Histopot Formalin Filled 70ml AHPHSP.70ML (20302) EACH     Jerry Can 4L, c/w Red Cap, Label & Bag RJC4LNATS+REDCAP (13730) EACH     Jerry Can 4L, c/w White Cap, Label & Bag RJC4LNATS+WHCAP (13709) EACH     Neutral Buffered Formalin 10% Blue ANBFB.2.5L (15181) EACH     Paediatric Urine Bag PUCS100ML (15280) EACH    BLOOD TUBES Product Code U.O.M. Qty.     Tube ESR 2ml Sodium Citrate Black Cap 454073 (36530) PACKET     Tube, LIHEP PLH 13x100 6.0 BLBLCE GN 367885 (16245) EACH     Tube, Vacutainer 6ml Dark Blue K2-EDTA 368381 (16236) EACH     Vacutainer BD Blue 1.8ml 3.2% Sodium Cit 363093. (50191) EACH     Vacutainer BD Blue 2.7ml 3.2% Na Citrate 363095 (16237) PACK     Vacutainer BD Gold SSTII 8.5ml Serum/Gel 367958 (16241) PACK     Vacutainer BD Grey 6ml 367925 (16248) PACK     Vacutainer BD Lavender 2ml EDTA 367836 (16249) PACK     Vacutainer BD Lavender EDTA 4ml 367839 (16250) PACK     Vacutainer BD Pink EDTA 6ml (X-match) 367941 (16252) PACK     Vacutainer BD Red 10ml Plain W/clot act. 367895 (16253) EACH     Vacutainer BD Yellow 6ml ACD 367756 (16257) EACH    HISTOLOGY/CYTOLOGY SUPPLIES Product Code U.O.M. Qty.     Alesbury Spatula 33040SA (11735) PACKET     Ayres Spatula, Wood WCSP (12049) PACKET     Cervex Brush, Rover, Blue 33023-RV (12610) PACKET     Cytology Brush 33009SA (12920) PACKET     Cytology Fixative Spray (Gribbles Label) 400-200-6M (12921) EACH     Lubricant Gel 42g K-Y Jelly 1067500 (36424) TUBE     Pap Collection Kit - Type 1, Ayres 33055GR (15849) KIT     Pap Kit - Gribbles Type 2, Cervex Brush 33054GY (15850) KIT     PreservCyt Solution 70098-002 (15463) VIAL     Speculum Medium Ratchet Type Sterile Ind SPEC/NING/M (15855) BAG     Speculum Small Ratchet Type Sterile Indi SPEC/NING/S (15856) BAG     Speculum Vaginal Large Ratchet Long Hand SPECRLHL (13091) EACH    SWABS / MEDIA Product Code U.O.M. Qty.     Kit Female Endocervical Specimen Collect 441357 (27122) EACH     Kit Male Urethral Specimen Collection fo 441358 (27123) EACH     Kit Urine Preservative Transport for BD 441362. (27160) EACH     Kit Vaginal Specimen Transport for BD Pr 441122 (27121) EACH     Swab Plain Sterile 155CIS (15923) EACH     Swab Skin Prep Alcohol 70% RHS417 (23469) BOX     Swab Skin Prep Water Sterile 1021 (15932) BOX     Swab Transport Amies Media 108CG (15924) EACH    INSTRUCTION PADS / FORMS Product Code U.O.M. Qty.     Form Pathology Request Metro A4 Blank HSPVFRM0025 (16384) PACKET     Form Pathology Request Metro A4 w/Labels HSPVFRM0023 (16385) PACKET    MISCELLANEOUS Product Code U.O.M. Qty.     Doctor Stores Order Form SUNDRY006 (18623) EACH     Form Path Request Pad Metro Blank 2 Part HSPVPAD0017 (16382) EACH     Glucose Tolerance Drink 300ml 50g Clear GTD50/P (13301) BOTTLE     Glucose Tolerance Drink 300ml 75g Clear GTD75P/CLEAR (13302) BOTTLE     Slide Mailer PP Clear, Healthscope Logo MAILER-21. (22784) PACKET     Slide Microscope Menzel Superfrost Plain SF21201 (15804) BOX   NOTE: ITEMS LISTED ARE APPROVED BY MEDICARE. PROHIBITED ITEMS WILL NOT BE SUPPLIED 13/02/2008 Authorised by: National Logistics Manager, VIC STO-DRSORDFOR-003 38.107.179.218