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 For Compass stock enquiries contact 03 9250 0360 Compass Clinical Trial Qty
Liquid-based Cytology and/or hpv Testing
Description For the Consulting Room Combined Request/Consent Forms
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Cervical Cytology Qty
Main Trial Recruitment Guide ThinPrep (PreservCyt® Solution) (25 Pack) Yellow Stickers (sheet) Patient Information (A4 50/Pad) For the Waiting Room Patient Information Brochure (DL) Poster A4 Version Poster A3 Version
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Chlamydia Testing Qty
Results Brochure Low Risk HPV Negative (Green) Results Brochure Unsatisfactory (Blue) Results Brochure Intermediate Risk (Orange) Results Brochure High Risk HPV (Red)
Description (b) Slide Containers (10 per pack) (c) Glass Slides (50 per pack) (d) Endocervical Brush (100 per pack) (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 (100 mL) Disposable Specula (i) Small (25 per pack) (i) Medium (25 per pack) (i) Large (10 per pack) image not shown
For the Clinic Compass Consumable Order Form Results Brochure Low Risk Cytology Negative (Green)
Description (a) ThinPrep (PreservCyt® Solution) (6 Pack) (a) ThinPrep (PreservCyt® Solution) (25 Pack)
Description (j) Flocked Swab (Chlamydia) (10 per pack) (k) Chlamydia and Pap Test Pack
Histology QTY
Description (l) Histology Containers and Zip Lock bags
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 (post only)
Use For > all specimens > posting single slides to VCS > HPV, ThinPrep and Histology samples > single or multiple samples
Pathology Request Forms* and Information Resources Qty
Pathology Request Forms (Green) Request Forms (for computer printing) Request Forms (manual with pre-printed practitioner details) – if details are different from above see over leaf
Corp-Fin-F-1V7 Issued February 2016
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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