Reference Lab Client Order Form

Call Mattoon Lab with questions:
217-258-4005 or Toll Free 1-800-573-1940

DO NOT order here if you are a SBL Clinic.

* indicates a required field.

Client Name: *

City: *

Person requesting supplies: *

Email: *

Date ordered: *
example 01/10/16

Collection Tubes

Blue Top 2.7 mL Flat(s):
Flat(s) = 100 Tubes

Blue Top 2.7 mL:
Each

Gold Top (SST) 5 mL Flat(s):
Flat(s) = 100 Tubes

Gold Top (SST) 5 mL:
Each

Lavender 3 mL Flat(s):
Flat(s) = 100 Tubes

Lavender 3 mL:
Each

Pink Top (Blood Bank only):
Each

Red Top 6 mL:
Each

Amber pour off tubes:
Each

Clear pour off tubes:
Each

TB Quant (set of 4):
Each

Collection Needles

21G x 1" Needle:
Box(es)

21G x 1.5" Needle:
Box(es)

22G x 1" Needle:
Box(es)

23G x 3/4" Safety Butterflies:
Only one box per request

Urine Containers

Urine/Stool specimen container:
Each

24 Hr urine container:
Each

Pedi bags (ubags):
Each

Specimen collections hats:
Each

Pap Smear

SurePath Pap Kits - Flat(s):
Flats(s)

Spatula/wire brush (SurePath):
Pkg(s)

Broom brush (SurePath):
Pkg(s)

ThinPrep Pap Kits - Flat(s):
Flat(s)

Spatula/Wire brush (ThinPrep):
Pkg(s)

Broom brush (ThinPrep):
Pkg(s)

Cytology

Cytolyt (Liter bottle):
Liter bottle

Cytolyt 30mL cup (single use):
Each

Dry Slide Transport Container:
- Each

Screw Top Wet Slide Transport Vials (Ethanol-Filled):
- each

Screw Top Wet Slide Transport Vials (Empty):
- each

Charged Slides (Box):
Box = 100 slides

Charged Slides (Set of 5):
Sets of 5 slides

95% Alcohol:
1 liter

Pathology

(Formalin Filled)

20mL: (Each):
Each

20mL: (Box):
Box

40mL: (Each):
Each

40mL: (Box):
Box

60mL: (Each):
Each

60mL: (Box):
Box

120mL: (Each):
Each

120mL: (Box):
Box

Additional Pathology Supplies:
See Pathology Dept.

Microbiology

C&S Stool Transport Vial:
Each

AlcorFix Transport (O&P):
Each

Blood Culture Kits - Adult:
Each

Blood Culture Kits - Peds:
Each

HSV swab kit:
Each

Aptima multi-test swab kit:
Each (For ARVP sendouts only)

CHL/GC Xpert Swab kit:
Each

Routine Culture Swab - Single:
Each

Routine Culture Swab - Double:
Each

Covid VTM:
Each

Nasal Swabs For Covid Test:
Each

Nasopharyngeal Swabs for Covid Test:
Each

Vaginitis Screen Kit (BD Affirm):
Each

Forms

Reference Lab Requisition (Pkg of 25):
Pkg(s)

Surgical Pathology Requisitions:
Each

Cytology Requisition:
Each

Miscellaneous Supplies

Biohazard Specimen Bags:
Pkg(s)

Latex-Free Tourniquets:
Each

Large Clear Sharps:
Each

Medium Clear Sharps:
Each

Small Red Sharps:
Each

Safety vacutainer hub:
Bag(s)

Alcohol prep wipes:
Box(es)

Paper:
Ream

Color:
Please choose between white or yellow

Toner/Ink:
Each - You must also included Cartridge Number below.

Cartridge number:

Atlas labels:
Roll

Other supplies not listed:

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Community Wellness

Resources Directory

Health Styles Magazine

Health Styles Podcast

Video Library

Reference Lab Client Order Form

DO NOT order here if you are a SBL Clinic.

Collection Tubes

Collection Needles

Urine Containers

Pap Smear

Cytology

Pathology

Microbiology

Forms

Miscellaneous Supplies

Resources Directory

Health Styles Magazine

Health Styles Podcast

Video Library

Reference Lab Client Order Form

DO NOT order here if you are a SBL Clinic.

Collection Tubes

Collection Needles

Urine Containers

Pap Smear

Cytology

Pathology

Microbiology

Forms

Miscellaneous Supplies

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