Order Form Back - api-pt.com

1 Send orders and payments to: Department 9526, Box 30516, Lansing, MI 48909-8016 800-333-0958 Fax: NumberHCO #LAP/CAP #COLA #API # (if applicable)___ ___ D ___ ___ ___ ___ ___ ___ ___Shipping InformationBilling InformationShipping ContactBilling ContactInstitution NameInstitution NameDepartmentDepartmentStreet Address (products cannot be shipped to a Box)Mailing AddressAddress 2 Address 2 CityStateZipCityStateZipPhone/Fax:Phone/ Fax:Email:Email:Send copies of reports to: (a copy will also be sent to the address above)Send additional copies of reports to: (attach a list if more than two)AttentionAttentionInstitution Name and AddressInstitution Name and AddressCityStateZipCityStateZipPhone/Fax :Phone/Fax:Email:Email:Quantity Unit PriceTotal$$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ *Additional Shipping Charges $*Call API for additional shipping costs if you are located in AK, PR or outside of the continental to.

2 Department 9526, Box 30516, Lansing, MI 48909-8016 2019 Order FormInnovative Solutions. Technical ID #Catalog NumberDescriptionIf you would like your Order shipped by department, please use a separate form for each department. Please use additional forms if more lines are & Processing $Visit to view our catalog or call us at 800-333-0958 to request a Order #:Authorized Signature:$99 Order Total $Sub-Total $*Additional shipping charges may apply for AK, PR and all others sent outside of the continental complete the attached form if paying by credit & COAGULATION (continued) microbiology (continued)137 Alcohol$337279 Hematology - 5H$315373 HSV 1 & 2 (molecular)$459138 Ammonia$189238 Hematology - 5S$325339 India Ink$181166 Amniotic Fluid pH$227226 Hematology - 5M$323333 KOH Preparation$184130 Apolipoproteins $181247 Hemochron Jr.

3 ACT - LR$250340 Legionella Antigen $153174 B-Ketone $207248 Hemochron Jr. ACT +$250366 MRSA/Staph aureus (molecular)$109111 Blood Gas$452252 Hemochron Jr. Citrate APTT $373356 MRSA Culture $110112 Blood Gas Plus $494249 Hemochron Jr. Citrate PT$368372 M. tuberculosis (molecular)$357172 Blood Lead - 5$429250 Hemochron Jr. PT$368371 Meningitis Panel$459173 Blood Lead (Waived) - 2$225209 HemoCue White Blood Cell Count$271344 Mycobacteriology Culture $357114 Blood Oximetry $347278 Heparin Assay$271331 Mycology Culture$332140 Cardiac Markers - 5 $350215 i-Stat ACT$285374 Mycoplasma pneumoniae (molecular)

4 $357920 Cardiac Markers - 2 $204208 Lamellar Body Count$230334 Parasitology$281165 Additional Volume Cardiac Markers$166255 Platelet Function - Aspirin Test$245370 Respiratory Panel$498121 Chemistry - Basic$250256 Platelet Function - PRU Test$245348 Rotavirus - 5 $296122 Chemistry - Comprehensive$456214 POC Coagulation A - 5 $264349 Rotavirus - 3 $174141 Chemistry - Additional Volume$114914 POC Coagulation A - 2 $207341 S. pneumoniae Antigen$153125 Chemistry - Endocrinology$222216 POC Coagulation B$269343 Shiga Toxin$235144 Chemistry - waived $181222 QBC Hematology $278364 Strep Pharyngeal (molecular) - 5 $247177 CSF & Body Fluid Chemistry $148223 Reticulocyte Count$242964 Strep Pharyngeal (molecular)

5 - 2 $114170 Cystatin C$306228 Sedimentation Rate - A$184313 Throat Culture - 5 $260148 Ethyl Glucuronide$211201 Sedimentation Rate - B$171952 Throat Culture - 2 $113142 Fetal Fibronectin$368202 Sedimentation Rate - C $171953 Throat Culture - 3 $118131 Fetal ROM$337203 Sedimentation Rate - D$275362 Trichomonas $298135 Fructosamine$159280 Sedimentation Rate - E$308314 Urine Culture - 5 $273126 Glycohemoglobin - 5 $375237 Sickle Cell Screen$205924 Urine Culture - 2 $181127 Glycohemoglobin - 2 $226244 Thromboelastogram$204376 Vaginal Panel$435179 Additional Volume Glycohemoglobin - 5 $102 IMMUNOLOGY357 VRE Culture $110167 Additional Volume Glycohemoglobin - 2 $51421 ANA - EIA & IFA methods $160367 VRE (molecular)

6 $108134 Glycohemoglobin - Whole Blood$217429 ANA - Latex kits$164322 Virology Package - 5 $341128 HemoCue - 5 $252424 ASO $143942 Virology Package - 2 $174928 HemoCue - 2 $153423 Anti-CCP$327933 Virology Package - waived methods - 2 $173133 Immunoassay - 3 $284441 BRCA1/2 Sequencing $949 VERIFICATION PROGRAMS 180 Immunoassay - 5 $398425 C-Reactive Protein - High Sensitivity$189160 Immunoassay - Special $190431 C-Reactive Protein$153145 i-Stat Chemistry - 5 $331419 Diagnostic Allergy$332945 i-Stat Chemistry - waived - 2 $199437 Additional Volume Diagnostic Allergy$92176 Lipid Plus - 5 $250420 H.

7 Pylori Antibody$159976 Lipid Plus - 2 $176439 HCV Viral Load $1,200236 Microalbumin$184440 HIV Viral Load $925147 Neonatal Bilirubin - 5 $212430 HSV-2 Antibody$204129 Neonatal Bilirubin - 2 $150438 Infectious Disease Serology $498169 Procalcitonin$520407 Immunology Package$447J16 ACT - Hemochron - 2 (916)$225171 SHBG and Testosterone $415436 Immunoproteins / C3 & C4 $220J17 ACT - Medtronic 2 (917)$179163 Sweat Analysis $266411 Infectious Mono & Rheumatoid Factor$257A37 Alcohol (137)$266132 Therapeutic Drugs $215410 Infectious Mononucleosis - 5 $164A38 Ammonia (138)$143136 Therapeutic Drugs - add on to Chemistry $94910 Infectious Mononucleosis - 2 $97E17 Auto Blood Bank (517)$561175 Thyroid - Special $209418 Lyme Disease$220E12 Blood Bank (512)$418150 Tumor Markers $424428 Mycoplasma Antibody$189A11 Blood Gas (111)

8 $102146 Urine Adulteration Test$201432 Rapid HIV - 5 $410A12 Blood Gas Plus (112)$102143 Urine Chemistry$310433 Rapid HIV - 2 $209A14 Blood Oximetry (114)$102139 Urine Drug Screen$260408 Rheumatoid Factor$160A40 Cardiac Markers - 5 (140)$179123 Whole Blood Glucose - 5 $260415 Rubella$161J20 Cardiac Markers - 2 (920)$123918 Whole Blood Glucose - 3 $159409 Serum HCG$164C47 C. difficile Toxin or Antigen - 2 (347)$115 URINALYSIS, MICROSCOPY & OTHER TESTS416 Syphilis Serology$199A21 Chemistry - Basic (121)$102261 Fecal Lactoferrin$169164 Thyroid Antibodies$306A22 Chemistry - Comprehensive (122)$102239 Gastric Occult Blood$184417 Viral Markers $520A44 Chemistry - waived (144)$138233 Provider Performed Microscopy $168 IMMUNOHEMATOLOGYB17 Coagulation (217)$143287 Add-on PPM photographs$30511 ABO / Rh$301E14 DAT (514)

9 $164260 Rapid Urease$155516 Antibody Elution$561B46 D-dimer Quantitative (246)$123273 Urine Crystals$346519 Antibody Titer - A$276B84 Fecal Occult Blood (284)$96258 Urine Eosinophils$77520 Antibody Titer - D$276B39 Gastric Occult Blood (239)$133289 Add-on Urine Eosinophils photographs$30521 Antibody Titer - AD$378A27 Glycohemoglobin - 2 (127)$215232 Urinalysis & HCG$147517 Automated Blood Bank$561J12 Group A Strep Antigen 2 (912)$97272 Urinalysis & HCG - I$181537 Auto Blood Bank w/ Electronic Crossmatch$872B20 Hematology - 5C2 (220)$271235 Urine HCG - Qualitative $164512 Blood Bank$431B21 Hematology - 3 (221)$271234 Urine Sediment$57532 Blood Bank w/ Electronic Crossmatch$735B27 Hematology - 3S (227)$271288 Add-on Urine Sediment photographs$30514 Direct Antiglobulin Testing$209B30 Hematology - 5C (230)$311270 Automated Urine Microscopy - I$206534 DAT - Automated $250B31 Hematology - 5A (231)

10 $311271 Automated Urine Microscopy - S$206518 Educational Blood Bank$200B38 Hematology - 5S (238)$313251 Waived & PPM Package$236515 Fetal RBC $306B40 Hematology - 5B (240)$311 ANDROLOGY513 Rh Slide Test$171B42 Hematology - 5D (242)$311154 Antisperm Antibody $268 MICROBIOLOGYJ28 HemoCue - 2 (928)$113162 Post-Vasectomy Sperm Analysis $268335 Acid Fast Smears$206B47 Hem