LAB-IN-A-BOX® SUPPLY ORDER FORM
LAB-IN-A-BOX?
SUPPLY ORDER FORM
Place Your Order In One of the Following Ways:
? Phone: 860-657-8271
? Fax: 888-631-5960
? E-mail: hhcsupplies@
Local Option (Please allow three to five days for your shipment to arrive).
Item No. HH5010
Product:
Components:
Contains: 2 green top, 1 gray top, 1 blue top, and purple top,
Lab-in-a-Box for Patient Service Center (PSC) LIAPouch, Vacutainer holder, luer adapter, safety vacutainer needle,
or Drop-Box Options.
test request form, wicking pad, biohazard bag, shipping container
(Styrofoam), and TempPacks.
Quantity:
Lab-in-a-Box for when it's necessary to ship the specimen via FedEx.
Contains: 2 green top, 1 gray top, 1 blue top, and purple top, LIAPouch, Vacutainer holder, luer adapter, safety vacutainer needle, TRF, wicking pad, biohazard bag, shipping container (Styrofoam), TempPacks, and FedEx Airbill with mailer.
FedEx? Option
HH5000
If you service this state:
Order this FedEx Option:
ME, NY, PA, VT, RI, CT, NH, NJ, MD, MA, DE FedEx Option Northeast, Raritan
VA, NC, SC
FedEx Option Atlantic, Burlington
TN, LA, MS, AL, GA
FedEx Option Southeast, Birmingham
WA, OR, CA
FedEx Option West, San Diego
KY, WV, IL, IN, MI, OH, WI
FedEx Option Central, North Dublin
TX, OK, AR, MO, KS, NE, IA, MN, ND, SD, ND, NM, AZ, CO, UT, NV, ID, , WY
FedEx Option Mid-America, Houston
FL
FedEx Option Florida, Tampa
Quantity:
Add-Ons
HHC100
HH6000 HH1000 108CC HHURINE 900312 900612 301012 OCPU-LBCP BHAL
Product:
Components:
Multi-Pack When drawing multiple patients, specimens can be packed together in one Lab-in-a-Box for drop off
Contains: 2 green top, 1 gray top, 1 blue top, and purple top, LIAPouch, Vacutainer? holder, luer adapter, safety vacutainer needle, test request form, wicking pad, and biohazard bag.
Trace Metal Pack
Contains: Lab-in-a-Box Multi-Pack and 2 navy top tubes
Blood Culture Pack
Contains: 2 Blood culture bottles
Culturette Swab
Contains: One culturette swab
Urine Pack
Contains: Culture tube, UA tube, collection cup, and transfer straw
Para-Pak? Clean Vial Stool
Contains: Para-Pak? Clean Vial Stool
Para-Pak? C&S Stool
Contains: Para-Pak? C&S Stool
Para-Pak? O&P Stool
Contains: Para-Pak? O&P Stool
Quantity:
iFOBT Stool
Contains: FOBT Stool
______________________________________ ________________________ __________________________________________
Date
Account No.
Company
______________________________________ ________________________ __________________________________________
City
Contact Person
Phone No.
________________________________________________________________________________________________________________ Ship-to address (only if different from account address)*
*Supplies cannot be shipped to a residential address.
FedEx is a registered trademark of Federal Express Corporation Vacutainer is a registered trademark of Becton Dickinson and Company ?2017 Laboratory Corporation of America? Holdings All rights reserved. L13011-0217-2
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