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
Qty
(a) ThinPrep® (6 Pack) (a) ThinPrep® (25 Pack)
Description (i) Specimen Bio Hazard Bags (100 per pack) > Use for all specimens (j) Reply Paid Satchel (post only) > Use for multiple specimens
Sampling Devices
(k) Pot Mailers > Use for histology specimens (l) Zip Lock bags > Use for all liquid-based and histology
(b) Flocked Swab (10 per pack) (c) (d) (e) (f)
VCS Courier and Mailing Supplies
specimens
Cervical Sampler – Broom Type (50 per pack) Endocervical Brush (100 per pack) Spatula – Plastic (50 per pack) Cervix Brush Combi (50 per pack)
Pathology Request Forms Request Forms (for printing) Request Forms (manual pre-printed with practitioner details) – see below
Information Resources
SPECULA (g) Small (25 per pack) (g) Medium (25 per pack) (g) Large (10 per pack)
Chlamydia – What is Chlamydia? (DL brochure) Chlamydia and Gonorrhoea Testing and Collection Methods
Self Collection
Chlamydia Poster Cervix Sampling Card
(b) Flocked Swab (10 per pack)
Histology
How to take your own HPV test Sending Pathology Specimens to VCS (A4 card) Triple bag system for liquid based cytology
(h) Histology Containers (tray of 10)
For detailed mailing instructions go to www.vcs.org.au/ practices/mailing.html For manual request forms, please provide details below to be pre-printed on the forms for each practitioner
(a) Thin Prep®
(b) F locked Swab
(c) C ervical Sampler – Broom Type
(d) Endocervical Brush
(e) Spatula – Plastic
(f) Cervix Brush Combi
(k) Pot Mailers (post only)
(l) Zip Lock Bags
PO Box 178 Carlto 752 Swans n South Phone ton : 03 9250St, Carlto VIC 3053 n VIC 0300 3053
VICT ORIA N Repl y Paid CYTOLOGY CARLTON 178 SERV ICE SOUTH VIC 3053
UN337 3 BIOL OGIC AL SUB
STAN
CES
– CATE
GOR
(g) Specula
Practitoner Name:
(h) Histology Containers
(i) Specimen Bio Hazard Bags
YB
(j) Reply Paid Satchel (post only)
Practitoner Name: PO Box 752 Swan178 Carlt on ston Phon St, South e: 03 9250 Carlton VIC 3053 0300 VIC 3053
Practitoner Name:
Practitoner Name: VICT ORI Reply AN CYT OLOGY Paid CARLTO 178 SERVICE N SOU TH VIC 3053
Corp Fin F 1 V11 Issued July 2018 UN33 73 BIOLOG
ICAL
SUBSTA
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S – CAT
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B