Consolidated Labs Supply Requisition Form

* CLS Account Number:

* Date:
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* Account Name:

* Address:

* Person Requesting Order:

* Contact Number:

For questions, call our main number (904) 308-5600 & press option 4. Please remember, all supplies requested on this form are intended solely for the purpose of sending specimens for testing to Consolidated Laboratory Services.

ITEM UOM Quantity Code
 Order    Ship  
Urine Collection
Clean Catch Kit each 1
Non-Sterile Urine Transport Tube 100/bag 2
Sterile Urine Container 20/bag 3
Urine C&S Tube 20/bag 4
Urine Cup Plastic (no top) 25/bag 5
24 Hour Urine Containers
Boric Acid each 6
Plain each 7
6N HCL each 8
Vacutainer Needles
22g x1" 48/box 11
21g x1" 48/box 12
Needle Holder (plastic) ea 34
Vacutainer Tubes
4.5ml Blue Top 50/box 13
4ml Lavender Top 50/box 14
5ml Serum Separator 50/box 15
7ml Gray Top 100/box 16
7ml Green Top 100/box 17
10ml Red Top - Plain 100/box 18
Microtainer Amber 10/bag 23
Microtainer EDTA 10/bag 24
Microtainer Red Top 10/bag 25
Transport Tube (plastic) 20/bag 84
Hypodermic Needles
21g x 1" each 27
23g x 1" each 28
5cc Syringe each 29
10cc Syringe each 30
20cc Syringe each 31
ITEM UOM Quantity Code
 Order    Ship  
Blood Culture Bottle set 36
Culturette 20/bag 38
Hemocult ICT Card each 39
Herpes/Viral Culturette 10/bag 81
Sputum Container each 41
Stool C&S each 43
Stool Container 8oz Cup 10/bag 45
Stool O&P each 44
Cobas Swab Female each 114
Cobas Urine Kit each 115
Cytology / Surgical Pathology
15 ml Formalin Bottle each 47
60 ml Formalin Bottle each 48
Cardboard Slide Mailer 20/bag 50
Frosted-End Slides 144/box 53
ThinPrep Pap Kit (Vial and Brush) each 111
ThinPrep Broom Only each 112
Urine Cytology Fixative each 56
ABN Form 100/pack n/a
Supply Requisition Form each n/a
Test Requisition Forms (lab slips) Call 308-5600 option 4 to order.
Alcohol Preps 200/box 57
Specimen Transport Bags 100/roll 74
Other / Miscellaneous
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