CERVICAL CYTOLOGY THINPREP CYTOLOGY AND/OR HPV TESTINGQTY DESCRIPTION QTY DESCRIPTION

(a) SlideContainers (i) SamplingVials(6pack)(b) GlassSlides(50perpack) (i) SamplingVials(25pack)

(c) EndocervicalBrush(100perpack) HISTOLOGY(d)Spatula-Plastic (j) HistologyContainers&ZipLockBags(e) CervicalSampler–BroomType(50perpack)(f) CervixBrushCombi(50perpack)(g) CytologyFixativeSpray(100ml)

QTY DISPOSABLE SPECULA(h) Small(25perpack)(h) Medium(25perpack)(h) Large(10perpack)image not shown

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

PLEASE INCLUDE YOUR PRACTICE NO. TO HELP PROCESS YOUR ORDER

VCS PRACTICE NUMBER: PHONE:

NAME:

ADDRESS:

POSTCODE:

PATHOLOGY REQUEST FORMS* & INFORMATION RESOURCESQTY PATHOLOGY REQUEST FORMS QTY INFORMATION RESOURCES

RequestForms (for computer printing) Paptestsandyou

RequestForms (manual with pre-printed practitioner details) - If details are different from above see over leaf

WhatifaPaptestresultisabnormalChlamydia-WhatisChlamydia

* Pathology request forms are suitable for all tests TakingaPaptestDVDTestingforChlamydiaDVDMailingPathologySpecimenstoVCSChlamydiaPoster(seeoverfordesigns)

Corp-Fin-F-1V9 Issued March 2014

(Print name)

Date:

Requested By: PTO for images of the consumables available.

VCS PATHOLOGY ABN35430554780

POBox178CarltonSouthVIC3053Phone:(03)92500300

CONSUMABLES ORDER FORM

TRANSPORTATION AND MAILING SUPPLIESQTY MAILER USE FOR

When ordering please consider

the most economical use of the mailing

supplies.

(n) SpecimenBioHazardBags(100perpack) >allspecimens(o) ReplyPaidEnvelopes >postingsingleslidestoVCS(p) TubeMailers >UriSWABs(q) PotMailers >HPV,ThinPrepandHistologysamples(r) ReplyPaidSatchel–CategoryB >singleormultiplesamples

CHLAMYDIA TESTINGQTY DESCRIPTION

(k) UriSWAB(ChlamydiaUrine)(10perpack)(l) FlockedSwab(Chlamydia)(10perpack)(m)Chlamydia&PapTestPack

VICTORIAN CYTOLOGY SERVICE

Reply Paid 178CARLTON SOUTH VIC 3053

BIOLOGICAL SUBSTANCES – CATEGORY B

PO Box 178 Carlton South VIC 3053

752 Swanston St, Carlton VIC 3053

Phone: 03 9250 0300

UN3373

MANUAL REQUEST FORMS (Provide details to be pre-printed on Manual Request Forms)

(a) Slide container (b) Glass slides (c) Endocervical Brush (d) Spatula - Plastic (e) Cervical Sampler Broom Type

(f) Cervix Brush Combi

(g) Cytology Fixative Spray (h) Disposable Specula (i) Thin Prep Sampling Vial (j) Histology Containers

CERVICAL CYTOLOGY, HISTOLOGY & HPV TESTING

(k) Uri SWAB (Chlamydia Urine)

(l) Flocked Swab (Chlamydia)

(m) Chlamydia & Pap Test Pack Contains slide & slide container, cervical sampler and flocked swab.

Chlamydia Posters

CHLAMYDIA TESTING

(n) Specimen Bag (o) Reply Paid Envelopes(post only)

(p) Tube Mailer (post only) (q) Pot Mailer (post only) (r) Reply Paid Satchel(post only)

TRANSPORTATION AND MAILING SUPPLIES

For detailed mailing instructions go to http://www.vcs.org.au/practices/mailing.html

VCS PRACTICE NUMBER: PHONE:

NAME:

ADDRESS:

POSTCODE:

A B C

CONSUMABLES ORDER FORM

VICTORIAN CYTOLOGY SERVICE

Reply Paid 178CARLTON SOUTH VIC 3053

BIOLOGICAL SUBSTANCES – CATEGORY B

PO Box 178 Carlton South VIC 3053

752 Swanston St, Carlton VIC 3053

Phone: 03 9250 0300

UN3373