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Request for Phlebotomy Collection Supplies
Client Account Name *
Client Account Number *
Contact First Name *
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Comments:
Supplies
Each
Requisitions (Each)
Pack
Lavender Top Tubes, 4.0ml Draw (100 pack)
Pack
Green Top Tubes, 4.0ml Draw (100 pack)
Pack
SST Tubes, 7.5ml Draw (100 pack)
Pack
Specimen Bags (100 pack)
Pack
Blood Collection Needle 21G (48 pack)
Pack
Blood Collection Needle 22G (48 pack)
Pack
Needle Holder (250 pack)
