Consumables Order Form Ordered by:
Position:
Practice Name: Address: Phone:
Date:
vcs Pathology Practice Number:
Email your order to stores@vcs.org.au or fax 03 9349 1977 This order form is also available at http://www.vcspathology.org.au/practitioners/consumables-order-form Liquid-based Cytology and/or HPV Testing Qty
Description (a) ThinPrep (PreservCyt® Solution) (6 pack) (a) ThinPrep (PreservCyt® Solution) (25 pack)
Cervical Cytology Qty
Qty
Chlamydia Testing
Description (b) Slide Containers (10 per pack) (c) Glass Slides (50 per pack) (d) Endocervical Brush (100 per pack)
Qty
Description (j) Flocked Swab (Chlamydia) (10 per pack) (k) Chlamydia and Pap Test Pack
Histology Qty
Collection Material (l) Histology Containers and Zip Lock Bags
Comments
(e) Spatula – Plastic (50 per pack) (f) Cervical Sampler – Broom Type (50 per pack) (g) Cervix Brush Combi (50 per pack) (h) Cytology Fixative Spray (100ml) DISPOSABLE SPECULA (i) Small (25 per pack) (i) Medium (25 per pack) (i) Large (10 per pack) image not shown
Transportation and Mailing Supplies Qty
Mailer (m) Specimen Bio Hazard Bags (100 per pack) (n) Reply Paid Envelopes (post only) (o) Pot Mailers (post only) (p) Reply Paid Satchel – Category B (post only)
Use For > all specimens > posting single slides to VCS > ThinPrep and Histology samples > single or multiple samples
Pathology Request Forms* and Information Resources Qty
Pathology Request Forms Request Forms (for computer printing) Request Forms (manual with pre-printed practitioner details) – if details are different from above see over leaf
Qty
Information Resources Pap tests and you (DL brochure) What if your Pap test result is abnormal (DL brochure) Chlamydia – What is Chlamydia? (DL brochure) Taking a Pap test (DVD) Mailing Pathology Specimens to VCS (A4 card) Chlamydia Poster PTO for images of the consumables available
Corp-Fin-F-1V10 Issued February 2016