Caris Cohen Dx is happy to provide complimentary supplies for all clients. When you need additional supplies, complete the form below and submit it to us over the internet. We will have the supplies ready for your next visit from our courier. You may also call your supply order directly in to our receptionist; this is the preferred method for urgent supply requests.

Enter a quantity request in the box located to the right of each listed item. For any item you do not need, leave the corresponding box blank. Click on any of the items for a description.

Supply Item Quantity Specimen bottles (10% formalin):         Small size (20 ml), 32 bottles/box box(es)      Medium size (30 ml), 24 bottles/box box(es)      Large size (120 ml), 24 bottles/box box(es) Michel's Media (for direct immunofluorescence)         Small size (20 ml) bottle(s) Red-top tube and packaging      (for indirect immunofluorescence) tube(s) Gout Pack, 1 bottle/pack      (95% ethanol solution for ruling out gout) pack(s) Biohazard bags, 100 bags/bundle bundle(s) Requisition forms (loose sheets) sheets Requisition forms (padded)*, 100 sheets/pad pad(s) Specimen Bottle Labels, 30 labels/sheet sheet(s) Tracking Cards, 100 cards/pack pack(s) Specimen Lock Box box(es)

* Padded requisitions are supplied only to clients still using the old version of our requisitions. Once that supply is exhausted, loose sheets of requisitions will be provided. If you need a blank Requisition Form immediately, click here. (To view this printable form you will need Acrobat™ Reader available free from Adobe™.)

Before submitting your request, please complete the fields below:

*Practice Name: *Street Address: **Suite Number: *City: *State: *Zip/Postal Code: *Phone Number: -- ext. Email Address:     An e-mail address is only required if you would like an e-mail confirmation of your order.

Specimen Bottles

Our specimen bottles contain 10% neutral buffered formalin and are available in three sizes:

Small – 20 mL
Medium – 30 mL
Large – 120 mL

Michel’s Media Bottles – for Direct Immunofluorescence

Our Michel's Media bottles are used to transport specimens for direct immunofluorescence studies. Our bottles have a bright green cover and are marked with a red dot to distinguish them from our regular specimen bottles. Michel’s Media is available in a convenient 20 mL bottle.:

Red-Top Glass Tubes – for Indirect Immunofluorescence

We provide red rubber topped glass tubes for submitting blood for indirect immunofluorescence studies. We also supply a small styrofoam box to ensure safe transport of the sample.

Gout Packs

We provide special specimen collection bottles containing a mixture of 95% ethanol for clinicians who wish to submit a specimen that is suspected for gout. Since these specimens require unique processing, our gout packs also contain special labels in order to alert our lab staff to the contents of the bottle and the special processing required.

Biohazard Bags

Our biohazard bags come in bundles of 100. They are designed with an interior zip-lock pouch to hold the specimen bottle and an exterior slip-pocket to hold the requisition form.

Customized Requisition Sheets

Requisition sheets are customized for our client offices. The “Referring Physician” section contains a list of physicians, along with the address of the office. We can also make small modifications to the standard form, upon request, to capture additional data (such as a patient ID number). Requisitions are delivered as stacks of loose sheets in a stationary box. We invite clients to return the empty box when they need to replenish their supply of requisitions.

Specimen Bottle Labels

For those offices that prefer not to write the patient name, doctor name, surgery site and date directly on the specimen bottle, we supply sheets of labels. After writing the necessary information onto the label, it must be peeled off the sheet and affixed to the bottle. Specimen bottle labels come in sheets containing 30 labels.

Specimen Tracking Cards

We encourage our clients to complete a specimen tracking card for every delivery of specimens that is sent with the courier. This card captures the office name, the date and the number of specimens submitted. This card must be signed by a member of the office staff and countersigned by our courier once he performs a secondary count. The top of the carbon sheet is left with the office and the bottom is put in the pouch and delivered to our lab with the specimens. Our tracking cards come in packs of 100.

Specimen Lockbox

We provide lockboxes for offices that require the flexibility of a secured spot to leave specimens for a courier to retrieve outside of their regular office hours. We retain one key to the box for our courier and give the other to the office.

320 Needham Street, Suite 200, Newton, MA 02464
TEL 617.969.4100 • FAX 617.969.3393
EMAIL info@cariscohendx.com

Copyright © 2007 Caris Cohen Dx. All rights reserved.