Lakeland Health Care
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**Note:  Federal regulations enable us to supply only those materials necessary to submit specimens to our facility for testing.**
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Lakeland Laboratory Phlebotomy Supply Order Form 
Date *  Calendar (mm/dd/yyyy)
Client Name * 
Client Address * 
Phlebotomy Supplies 
ACD Solution B Tubes 
Blood Culture Vials, Adult 
Blood Culture Vials, Pediatric 
Clear Top Tubes (No Additive) 
Dark Blue (EDTA) 
Gold Serum Separator (SST) 3.5 mL 
Gold Serum Separator (SST) 5.0 mL 
Green Top Gel Barrier (Mint PST) 
Green (Lithium Heparin) 
Green (Sodium Heparin) 
Lavender (EDTA) 3.0 mL 
Lavender (EDTA) 6.0 mL 
Light Blue (Sodium Citrate) 
Red Top (serum) Tubes 
Pearl Top Tubes (K2EDTA) 
Biohazard Bags, Small 
Biohazard Bags, Large 
Needle Disposal Sharps Container, Small (1 Quart) 
Needle Disposal Sharps Container, Large 
Vacutainer Needles 21G, 1 inch (48 per box) 
Vacutainer Tube Holders (250 per bag) 
Other 
Authentication * 

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