HHC Supply Request
Type or select the quantity of each item needed.
* Required
RN Name & Address:
*
Your answer
If needed for a scheduled visit, what date must supplies be received? (Supplies ship by 12 pm Mon/Wed/Fri and take 2 days to arrive.) Orders entered after 12 will be shipped the following shipping day.
*
MM
/
DD
/
YYYY
Serum Tubes (Gold/Tiger Top)
Your answer
EDTA Tubes (Lavender Top)
Your answer
Whole Blood Tubes (Red/Burgundy Top)
Your answer
Sodium Citrate Tubes (Light Blue)
Your answer
Syringes (10 ml)
Your answer
18G Blunt Fill Needles
Your answer
Butterfly Needle (23G) w/ Tourniquet
Your answer
Vacutainer (21G or 22G Needle w/ Tube Holder & Tourniquet)
Your answer
Masks
Your answer
Visit Documentation (Hard Copies)
Standard Clinical Notes (Qty 15)
Titration Notes (Qty 10)
Initial Assessment (4 pages - Qty 5)
Supply Forms (Qty 10)
Narrative Notes (Qty 10)
Consent Forms (Qty 5)
HHC T-Shirt
S
M
L
XL
XXL
3XL
Miscellanelous Items (Check Any/Each)
SMALL Gloves (Bag of ~50)
MEDIUM Gloves (Bag of ~50)
LARGE Gloves (Bag of ~50)
Purell Hand Wipes (Qty 15)
Alcohol Swabs (Qty 15)
Lab Labels (1/2 Page - 15 labels)
Lab Labels (Full Page - 30 labels)
HHC Business Cards (Qty 15)
Bio-Bags (Qty 5)
Bio Bags (Qty 10)
Sharps Container
Band-Aids & Gauze (10 each)
Thermometer
Notice of Patients Rights Cards (5)
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