STI/HIV Prevention Phlebotomy Supplies Request

STI/HIV Prevention Phlebotomy Supplies Request


Note: The following supplies may only be ordered by STI/HIV Contracted Rapid Test Sites. Shipping of items is subject to availability. Submitting a request for materials does not guarantee shipment of materials. For laboratory testing supplies (Multi-tube bottle with mailing box and Serum Separator Tubes) please visit the following link: http://www.kdheks.gov/labs/cust_serv/download/specimen_kit_request_form.pdf. If you have any questions, please contact the STI/HIV Prevention Program at 785-296-5595 or 785-296-7716.


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*Agency/Organization or Affiliation:


*Contact Person:


*Shipping Address:


*City:

*Zip Code:

*Phone Number:

*Email:


          Supplies:                                                Number Requested:   
Alcohol Pads (200/Box):                             

 
Iodine Pads (100/Box):

Band-Aids, Non-Latex (100/Box):              

 
2x2 Sterile Gauze (100/Box):

Cotton Balls (500/Pack):                             

Gloves, Non-Latex, Large (100/Box):        

 
Gloves, Nitrile, Large (100/Box):

Gloves, Non-Latex, Medium (100/Box):    

 
Gloves, Nitrile, Medium (100/Box):

Tourniquet Band, Non-Latex (250/Box):    

Procedure Towel:                                          

Sharps Containers, 1 Gallon:                        

Vacutainer (250/Bag):

Blood Collection Needle (48/Box):       


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