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Clinical Affairs - Materials Management



Central Sterilization Order Form


Orders should be received no later than 5:00 PM the day prior to date needed. Orders are filled on a first come first serve basis.

(* Required Items)

Department/Clinic*:
Room #*:
Contact*:
Email Address*:
Phone*:
Date Needed*: (i.e. 01/01/10)
Time Needed*: (i.e. 8:00 am)
Remember Me:

 

CASSETTES     (Enter Quantity Required,
               leave field blank if you don't want any)
# items currently
Checked out
#1 Exam
#2 Scaling
#5 Crown and Bridge
#6 Endodontic
#7 Pediatric Operative
#8 Pediatric Recall
#9 Pediatric Scaling
OP Operative
RP Removable Prosthodontics
RD Rubber Dam
OT Other

HANDPIECES     (Enter Quantity Required, leave field blank if you don't want any)

Highspeed - Midwest
Highspeed - NSK
Motor (Slowspeed)
Straight Attachment
Latch Attachment

BURS     (Enter Quantity Required, leave field blank if you don't want any)

E-Cutter
Amalgam/Polish
Polish
Crown
Composite

ULTRASONIC TIPS     (Enter Quantity Required, leave field blank if you don't want any)

Blue
Black
3 pk. Cassette

GOWNS
(Enter Quantity Required, please order by the bundle, one bundle = @ 20 gowns, leave field blank if you don't want any)

# of Gown Bundles

TOWELS     (Enter Quantity Required, leave field blank if you don't want any)

# of Towels

COMMENTS
(Leave blank if no comments)