Lakeland Health Care

Email Forms Manager

**Note:  Federal regulations enable us to supply only those materials necessary to submit specimens to our facility for testing.**

* Indicates required information
Lakeland Laboratory Microbiology Supplies Order Form 
Date *  (mm/dd/yyyy)
Client Name * 
Client Address * 
Anaerobic Transport Tubes 
Chlamydia/CG PCR Male or Female Urine (Cobas PCR Urine Packet) 
Chlamydia/GC Female Cervical Swab (Cobas PCR Female Swab Packet) 
GC Culture - Male (Green top eSwab) 
GC Culture - Female (White top eSwab) 
Group B Strep by PCR swab (Red Top Swab) 
Nasopharyngeal Culture Swabs (Green top eSwab) 
Ova And Parasite Collection Vial (Yellow) with Instructions 
Plain Specimen Container, Sterile 
Stool Culture Collection Vial (Orange) with Instructions 
Routine Culture Swabs (White top eSwab) 
M4 Viral Transport Media 
Flu/RSV/Viral Screens (M4RT) 
Viral Cultures (M4 Blue Top) 
Authentication * 

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    Center for Outpatient Services, St. Joseph  
    Hospice at Home Lakeland HealthCare Affiliate  
    Lakeland Community Hospital, Niles  
    Lakeland Community Hospital, Watervliet  
    Lakeland Regional Medical Center, St. Joseph  
    Lakeland Specialty Hospital, Berrien Center  
    Lakeland HealthCare Affiliate Physician Practices    
© 2014   Lakeland HealthCare   1234 Napier Avenue   St. Joseph, Michigan 49085   1-800-968-0115
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