Yosemite Pathology
NEWS & MEDIA
SUBMIT PAYMENT
209.577.1200
888.644.9764
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NEWS & MEDIA
SUBMIT PAYMENT
SUPPLY ORDER FORM
FAX TO
(209) 577-1725
CALL
(209) 577-1200 ext. 295
Date
*
Client Name
*
Client Account Number
*
REQUISITION / FORMS
Cytology/GYN (PAP’s)
Prostate
Histology/Non-GYN Cytology
Gastroenterology
Custom Print Requisitions
Supply Order Forms
SUPPLIES
Prostate Kits - 12 Bottles
Prostate Kits - 28 Bottles
Prostate Kits - Cassettes
Formalin Bottles (7 ml)
Formalin Bottles (15 ml)
Formalin Bottles (20 ml)
Formalin Bottles (40 ml)
Formalin Bottles (60 ml)
Formalin Bottles (90 ml)
Formalin Bottles (120 ml)
SurePath™ vial & accessories (broom or brush*) 25 per
ThinPrep ® vial & accessories (broom or brush*) 25 per
ThinPrep ® vial & accessories (broom or brush*) 25 per
Single PAP Folders with slides 25 per
Spirabrush CX ®
Cervex-Brush Combi
Aptima ® Vaginal Swab
BD Affirm™ Transport Tubes
CytoLyt Solution 30 ml Tube
CytoLyt Solution 30 ml Cup
CytoLyt Fixative 4 oz. Spray Bottle
Hematopathology Kit/Bone Marrow Kit
PCA3 Test Kit
Slides (100 pack)
Urine cups (4.5 oz. sterile)
8 oz. Containers
16 oz. Containers
32 oz. Containers
64 oz. Containers
92 oz. Containers
Specimen Bags - Small
Specimen Bags - Large
Specimen Lock Box
* Please specify
broom
or
brush
accessories Other (Please specify)
PLEASE ALLOW 3 DAYS FOR DELIVERY
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FAX TO (209) 577-1725
CALL (209) 577-1200 ext. 295 FAX TO (209) 577-1725 CALL (209) 577-1200 ext. 295