PoCT order form

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Date requested (dd/mm/yyyy):

Product required (NOT general Pathology supplies)

Glucose Meter Test Strips (Roche Performa) pot of 50

Urine Test Strips (Roche Combur 7) pot of 100

INR Test Strips (for Roche Coaguchek) pot of 24

INR Quality Control (for Roche Coaguchek) box of 4

Pregnancy Tests (manual or reader) box of 35

Ketone test strips (for Menarini meter) pot of 10

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Last updated: June 1, 2018