Office Name:
Account Number:
Address:
Ordered By:

CYTOLOGY SUPPLIES		QUANTITY
	Conventional Pap Paks (slide, fixative & collection device included)		Boxes (25 kits/box)
Liquid Based Pap Supplies:
	SurePath Collection Vial (Blue Top)		Each
	ThinPrep Collection Vial (White Top)		Each
Specimen Collection Devices:
	Cervix Brush (Mop)		Each
	Cervix Brush (Scored Cytobrush)		Each
	Plastic Scored Spatula		Each
	30 ml green top tube with CytoLyt (cytology fixative)		Each
	30 ml green top tube - Empty		Each
	CytoLyt (cytology fixative) - Quart		Each
TISSUE SUPPLIES
	Formalin Tissue bottles - 20ml		Each/Box (32)/Case (256)
	Formalin Tissue bottles - 40ml		Each/Box (32)/Case (256)
	Formalin - Gallon		Each
	Empty Specimen Containers - 40ml		Each
	Empty Specimen Containers - 90ml		Each
	Empty Specimen Containers - 400ml		Each
	Empty Specimen Containers - Liter		Each
	Wax Bucket (White) - 1 Gallon		Each
	Wax Bucket (Blue) - 1/2 Gallon		Each
	Plastic Bucket - 1 Gallon		Each
	InCyte Specimen Bag - 6 X 9		Each (100/pack)
	InCyte Blank White Labels		Each
	Specimen Manifest		Each (100/pack)
	Manifest Bags - Large (12 X 15)		Each (50/pack)
	Oral Pathology Biopsy Kits (Tissue bottle, requisition, shipping kit included)		Each
REQUISITION FORMS
	Cytology/Histology		Each
	Dermatology Slips		Each
	Oral Pathology		Each

We realize that we all work in an ever-changing environment. If there has been a recent change in your office that you would like us to make on your requisition, please note it below.

InCyte Pathology is happy to provide collection supplies at no charge for samples submitted to our laboratory.
Thank you for this opportunity to serve you.