INTERSCOPE PATHOLOGY
MEDICAL GROUP

21114 Vanowen Street
Canoga Park, CA 91303
Tel (818) 992-7890
Fax (818) 992-7943

Tissue and Pap Supply Request

Date:
*Doctor:
*Email:
Amount

Item                            *Required field
 Aspiration Tube for Non-Gyn Cytology (CytoLyt fixative)

 Cytology Requisitions (Pink)
 Cytology Spray Fixative
 Digene Collection Device-HPV
 Non-Gyn Cytology Slide Containers (95% Alcohol)
 Conventional Pap Kits (all inclusive)
 Specimen Transport Bags
 Specimen Transport Bags (Extra Large)
 Supply Request Pads
 20 ml Tissue Containers (10% Formalin)
 40 ml Tissue Containers (10% Formalin)
 120 ml Tissue Containers (10% Formalin)
 180 ml Tissue Containers (10% Formalin)
 480 ml Tissue Containers (10% Formalin)
 16 oz. Tissue Containers (10% Formalin)
 32 oz. Tissue Containers (Empty)
 64 oz. Tissue Containers (Empty)
 1 gal. Formalin
 Tissue Requisitions (Blue)
 ThinPrep Pap Specimen Vials
 ThinPrep Pap Brush / Spatula Combination Sampling Devices
 ThinPrep Pap Broom Sampling Devices
Other