Consumables Order Form

CONSUMABLES ORDER FORM Email your order to: stores@vcs.org.au or fax: 03 9349 1977 This order form is available at http://www.vcs.org.au/practices/consumables.html

VCS PATHOLOGY ABN 35 430 554 780 PO Box 178 Carlton South VIC 3053 Phone: (03) 9250 0300

PLEASE INCLUDE YOUR PRACTICE NO. TO HELP PROCESS YOUR ORDER VCS PRACTICE NUMBER:

PHONE:

NAME: ADDRESS: POSTCODE:

CERVICAL CYTOLOGY QTY

QTY

THINPREP CYTOLOGY AND/OR HPV TESTING

DESCRIPTION (a) Slide Containers (b) Glass Slides (50 per pack) (c) Endocervical Brush (100 per pack) (d) Spatula - Plastic (e) Cervical Sampler – Broom Type (50 per pack) (f) Cervix Brush Combi (50 per pack) (g) Cytology Fixative Spray (100ml) DISPOSABLE SPECULA (h) Small (25 per pack) (h) Medium (25 per pack) (h) Large (10 per pack) image not shown

QTY

DESCRIPTION (i) Sampling Vials (6 pack) (i) Sampling Vials (25 pack)

histology (j) Histology Containers & Zip Lock Bags

CHLAMYDIA TESTING QTY

DESCRIPTION (k) UriSWAB (Chlamydia Urine) (10 per pack) (l) Flocked Swab (Chlamydia) (10 per pack) (m) Chlamydia & Pap Test Pack

TRANSPORTATION AND MAILING SUPPLIES QTY

MAILER (n) Specimen Bio Hazard Bags (100 per pack) (o) Reply Paid Envelopes (p) Tube Mailers (q) Pot Mailers (r) Reply Paid Satchel – Category B

USE FOR > all specimens > posting single slides to VCS > UriSWABs > HPV, ThinPrep and Histology samples > single or multiple samples

When ordering please consider the most economical use of the mailing supplies.

PATHOLOGY REQUEST FORMS* & INFORMATION RESOURCES QTY

PATHOLOGY REQUEST FORMS Request Forms (for computer printing) Request Forms (manual with pre-printed practitioner details) - If details are different from above see over leaf

* Pathology request forms are suitable for all tests

Date: Requested By:

(Print name)

QTY

INFORMATION RESOURCES Pap tests and you What if a Pap test result is abnormal Chlamydia - What is Chlamydia Taking a Pap test DVD Testing for Chlamydia DVD Mailing Pathology Specimens to VCS Chlamydia Poster (see over for designs) PTO for images of the consumables available.

Corp-Fin-F-1V9 Issued March 2014

CONSUMABLES ORDER FORM CERVICAL CYTOLOGY, HISTOLOGY & HPV TESTING

(a) Slide container

(b) Glass slides

(g) Cytology Fixative Spray (h) Disposable Specula

(c) Endocervical Brush

(d) Spatula - Plastic

(i) Thin Prep Sampling Vial

(j) Histology Containers

(e) C ervical Sampler Broom Type

(f) Cervix Brush Combi

CHLAMYDIA TESTING

A (k) U ri SWAB (Chlamydia Urine)

(l) Flocked Swab (Chlamydia)

(m) Chlamydia & Pap Test Pack

B

C

Chlamydia Posters

Contains slide & slide container, cervical sampler and flocked swab.

TRANSPORTATION AND MAILING SUPPLIES PO Box 752 Swan178 Carlt on ston Phon St, South e: 03 9250 Carlton VIC 3053 0300 VIC 3053

VICTOR Reply IAN CYT OLOGY Paid CARLTO 178 SERVIC N SOU E TH VIC 3053

UN33 73 BIOLOG

ICAL

SUBSTA

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S – CAT

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(n) Specimen Bag

(o) Reply Paid Envelopes (post only)

(p) Tube Mailer (post only)

(q) Pot Mailer (post only)

B

(r) Reply Paid Satchel (post only)

For detailed mailing instructions go to http://www.vcs.org.au/practices/mailing.html MANUAL REQUEST FORMS (Provide details to be pre-printed on Manual Request Forms)

PO Box 752 Swa 178 Carl Phone: nston ton South VIC 3053 03 9250St, Carl 0300 ton VIC 3053

VCS PRACTICE NUMBER:

PHONE: VICTO RIAN Reply CYTO LOGY Paid CARL 178 SERV TON ICE SOUT H VIC 3053

NAME: ADDRESS:

UN33 73 BIOLO

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POSTCODE:

NCES

– CA TEGO

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