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Floor Grade Instruments DIGITAL ORDER FORM YOU MUST DOWNLOAD THIS FILE TO COMPLETE FLOOR GRADE INSTRUMENTS 1. PLEASE COMPLETE THE INFORMATION BELOW Account Name__________________________________________________ Contact Name ___________________________________________________________ Customer Acct. Number (STERIS IMS) ___________________ Phone Number __________________________________________________________ Fax Number _____________________________________________________ Email Address ____________________________________________________________ Shipping PO# _______________________ Address _____________________________________City __________________________________State ________ Zip_____________ 2. ENTER PACKAGE QUANTITY IN THE SPACES PROVIDED: SCISSORS ITEM # DESCRIPTION QTY PR.113-104 Iris | Straight | 4.5in | Qty 25 PR.113-105 Iris | Curved | 4.5in | Qty 25 PR.113-009 PR.113-11158 Lister | Bandage | 5.5in | Qty 25 PR.113-11159 Lister | Bandage | 7.5in | Qty 25 PR.113-1441 Lister | Bandage | 4.5in | Qty 25 PR.113-052 Littauer | Stitch | 15.5in | Qty 25 PR.113-0521 Littauer | Stitch | 4.5in | Qty 25 PR.113-007 Mayo | Straight | 5.5in | Qty 25 PR.113-010 PR.113-009 Mayo | Straight | 6.75in | Qty 25 PR.113-010 Mayo | Curved | 6.75in | Qty 25 PR.113-018 Metzenbaum | Curved | 7in | Qty 25 PR.113-016 Metzenbaum | Curved | 5.75in | Qty 25 PR.113-1121 Metzenbaum | Curved | 5.75in | Qty 25 PR.113-055CBB CONTINUE THROUGH THE NEXT PAGES, ENTERING QUANTITY. SEND FORM TO [email protected]. 1 SCISSORS ITEM # DESCRIPTION QTY PR.113-0063 Voper | Blunt | Straight | 5.5in | Qty 25 PR.113-055CBB Operating | Blunt| Curved | 4.5in | Qty 25 PR.113-055 Operating | Sharp/Blunt | Straight | 4.5in | Qty 25 PR.113-106 Operating | Sharp/Blunt | Straight | 5.5in | Qty 25 PR.113-006S Operating | Sharp/Sharp | Straight | 5.5in | Qty 25 PR.113-027 Roger Wire Cutting | Angled | 4.75in | Qty 25 PR.113-111761 Utility | Black Plastic Handle | 5.5in | Qty 25 PR.113-11176GR Utility | Green Plastic Handle | 5.5in | Qty 25 PR.113-11176OR Utility | Orange Plastic Handle | 5.5in | Qty 25 PR.113-100540 Utility | Black Plastic Handle | 7.5in | Qty 25 PR.113-11177PK Utility | Pink Plastic Handle | 7.5in | Qty 25 PR.113-11177RD Utility | Red Plastic Handle | 7.5in | Qty 25 PR.113-11184 Northbent | Suture | 4.5in | Qty 12 PR.113-243 PR.113-244 PR.113-246 TOWEL CLAMPS ITEM # DESCRIPTION QTY PR.113-243 Backhaus | Towel | 3.25in | Qty 25 PR.113-244 Backhaus | Towel | 5.25in | Qty 25 PR.113-246 Lorna Edna | Towel | Non-Perforating | 5.25in | Qty 25 KNIFE HANDLES ITEM # DESCRIPTION QTY PR.113-801 #3 | Qty 12 PR.113-802 #4 | Qty 25 PR.113-301 PR.113-802 PR.113-3094 Gigli | Saw Handles T-Shaped | Qty 12 SPECULUMS ITEM # DESCRIPTION QTY PR.113-27730 Graves | Vaginal | Virgin | Qty 12 PR.113-7051 Graves | Vaginal | Small | Qty 25 PR.113-7052 Graves | Vaginal | Medium | Qty 25 PR.113-7053 Graves | Vaginal | Large | Qty 25 PR.113-27751 Pederson | Vaginal | Medium | Qty 25 PR.113-27751 PR.113-7053 PR.113-7059 Pederson | Vaginal | Large | Qty 25 CONTINUE THROUGH THE NEXT PAGES, ENTERING QUANTITY. SEND FORM TO [email protected]. 2 HEMOSTATIC FORCEPS ITEM # DESCRIPTION QTY PR.113-271 Babcock | Intestinal | 6.25in | Qty 25 PR.113-714 Bozeman | Serrated | Curved | 10.5in | Qty 25 PR.113-212 PR.113-211 Crile | Straight | 5.5in | Qty 25 PR.113-212 Crile | Curved | 5.5in | Qty 25 PR.113-14252 Ballenger | Sponge Forcep | Serrated | 7in | Qty 25 PR.113-293 Foerster | Sponge Forcep | Serrated | 9.5in | Qty 25 PR.113-284 Foerster | Sponge Forcep | Curved | 9.5in | Qty 25 PR.113-203 Halsted Mosquito | Straight | 5in | Qty 25 PR.113-205 Halsted Mosquito | Curved | 5in | Qty 25 PR.113-211 PR.113-1811 Hartmann Mosquito | Straight | 3.5in | Qty 25 PR.113-1801 Hartmann Mosquito | Curved | 3.5in | Qty 25 PR.113-209 Kelly | Straight | 5.5in | Qty 25 PR.113-106151 Kelly Rankin | Curved | 6.25in | Qty 25 PR.113-210 Kelly | Economy | Curved | 5.5in | Qty 25 PR.113-274 Schroeder | Uterine Tenaculum | 9.5in | Qty 12 PR.113-293 PR.113-26735 Lahey | Longitudinal Serrations | Fully Curved | 7.5in | Qty 12 PR.113-299 Magill | Catheter | Adult | Qty 12 PR.113-300 Magill | Catheter | Child | Qty 25 PR.113-15259 Presbyterian | Tube Occluding | 5.5in | Qty 25 PR.113-15260 Presbyterian | Tube Occluding | Smooth | 6.5in | Qty 25 PR.113-223 Rochester-Pean | Straight | 6.25in | Qty 25 PR.113-224 Rochester-Pean | Curved | 6.25in | Qty 25 PR.113-225 Rochester-Pean | Straight | 7.25in | Qty 25 R.113-274 PR.113-226 Rochester-Pean | Curved | 7.25in | Qty 25 PR.113-228 Rochester-Pean | Curved | 8in | Qty 25 PR.113-12221 Rochester-Carmalt | Straight | 6.25in | Qty 25 PR.113-12223 Rochester-Carmalt | Curved | 6.25in | Qty 25 PR.113-7182 Rochester-Carmalt | Curved | 8in | Qty 25 PR.113-267 Allis | 4X5 Teeth | 6in | Qty 25 PR.113-21394 Doyle Intestinal Forceps | 9in PR.113-228 CONTINUE THROUGH THE NEXT PAGES, ENTERING QUANTITY. SEND FORM TO [email protected]. 3 SPECIALITY ITEM # DESCRIPTION QTY PR.113-02462 Taylor Hammer | 6.75in | Qty 25 PR.113-02463 Taylor Hammer | 7.5in | Qty 25 PR.25-730 Tuning Fork | C-64 PR.25-733 Tuning Fork | Alloy | 512c PR.113-32912 Nail Nipper | Barrel Spring | 4.5in | Qty 12 PR.113-32913 Nail Nipper | Barrel Spring | 5.5in | Qty 12 RETRACTORS ITEM # DESCRIPTION QTY PR.113-25562 Crile Ragnell | Double Ended |Qty 12 PR.113-601 Senn | Double Ended | Sharp | Qty 25 PR.113-602 Senn | Double Ended | Blunt | Qty 25 PR.113-26568 Cushing Vein| 9in | Qty 12 PR.113-26705 Pediatric Balfour | 4in | Fenestrated PR.113-26581A Gelpi | 4.5in | Qty 12 ENT & OPHTHALMIC ITEM # DESCRIPTION QTY PR.113-25705 Ear Loops | Billeau | Small | 2.5mm | Qty 12 PR.113-25706 Ear Loops | Billeau | Medium | 3mm | Qty 12 PR.113-25707 Ear Loops | Billeau | Large | 6.5mm | Qty 12 PR.113-25711 Hartman Alligator | Serrated Jaw | 7.5in | Qty 12 PR.113-25712 Hartman Alligator | Serrated Jaw | 6.5in | Qty 12 PR.113-22480 Grooved Director Probe | 5in | Qty 25 PR.113-180201 Probe with Eye | 5in | Qty 25 PR.113-23495 Probe with Eye | Malleable | 5.5in | Qty 25 PR.113-23496 Probe with Eye | Malleable | 6in | Qty25 PR.113-460401 Dilator | Trousseau Tracheal | 5.5in PR.113-460420 Tracheal Hook | 6in PR.113-6191 Joseph Skin Hook | Sharp | 6.25in | Qty 25 PR.113-24692RO Von Graefe Strabismus Hook | 5.5in PR.113-43246 Killiam Nasal Speculum | 6in | Qty 12 PR.113-25696 Jansen Bayonet Nasal Forcep | 8in | Qty 12 SUCTIONS ITEM # DESCRIPTION QTY PR.113-25794 Frazier Suction Tube | 7.25in | 10fr | Qty 25 PR.113-25796 Frazier Suction Tube | 7.25in | 12fr | Qty 25 CONTINUE THROUGH THE NEXT PAGES, ENTERING QUANTITY. SEND FORM TO [email protected]. 4 NEEDLE HOLDERS ITEM # DESCRIPTION QTY PR.113-405 Webster | Smooth | 5in | Qty 25 PR.113-2801 Mayo-Hegar | 5.25in | Qty 25 PR.113-16287 Mayo-Hegar | 6in | Qty 25 PR.113-415 Mayo-Hegar | 7in | Qty 25 PR.113-416 Mayo-Hegar | 8in | Qty 25 PR.113-16291 Mayo-Hegar | 10in | Qty 25 PR.113-16306 Castroviejo| 5.5in | straight | smooth with lock PR.113-16285 Baumgartner | 5.25in | Qty 25 PR.113-16238 Derf | 4.75in | Qty 25 PR.113-16296 Olsen-Hegar | 5.5in | Qty 25 PR.113-16297 Olsen-Hegar With Scissor | 6.5in | Qty 25 TISSUE AND DRESSING FORCEPS ITEM # DESCRIPTION QTY PR.113-24666 Iris | 1X2 Teeth | Serrated | 4in | Qty 25 PR.113-24665 Iris | Dressing | Full Curved | 4in | Qty 25 PR.113-24683 Bishop-Harmon | Iris | 1X2 Teeth | Straight | 3.375in | Qty 25 PR.113-19363 Jewelers | Fine Tip | #4 | 3.375in | Qty 25 PR.113-24663 Eye Dressing | Serrated | Straight | 4in | Qty 25 PR.113-17318 PR.113-24664 Eye Dressing | 1/2 Curved | 4in | Qty 25 PR.113-19351 Brown-Adson | 4.75in | Qty 25 PR.113-17318 Dressing | Serrated | 5.5in | Qty 25 PR.113-25695 Jansen | Ear | 6.5in | Qty 25 PR.113-25693 Lucae | Ear | 5.5in | Qty 25 PR.113-19363 PR.113-20372 Splinter | 3.5in | Non-Serrated | Qty 25 PR.113-20373 Splinter | Fine Points | Serrated | 4.5in | Qty 25 PR.113-255 Thumb Dressing | 1X2 Teeth | 5.5in | Qty 25 PR.113-17315 Thumb Dressing | 5in | Qty 25 PR.113-2491 Thumb Dressing | Serrated | 5in | Qty 25 PR.113-17319 Thumb Dressing | Serrated | 6in | Qty 25 PR.113-260 Adson | 1X2 Teeth | Serrated | 4.75in | Qty 25 PR.113-262 Adson | 1X2 Teeth | 4.75in | Qty 25 PR.113-18332 Tissue | 6in | 1x2 Teeth | Qty 25 PR.113-262 PR.113-18333 Tissue | 8in | 1x2 Teeth | Qty 25 CONTINUE TO THE NEXT PAGE, ENTER YOUR QUANTITY. THEN TOTAL ITEMS. SEND FORM TO [email protected]. 5 CREUTZFELDT-JAKOB DISEASE (CJD) INSTRUMENT SET Single-Use, German-Quality Surgical Instruments DID YOU KNOW... NORMAL STERILIZATION PROCEDURES DO NOT DESTROY CJD PRIONS. “For optimal management of CJD Procedures, the WHO (World Health Organization) recommends the use of disposable surgical instruments that are incinerated post-operatively. “ — AORN —AORN Journal. October 2014, Volume 100, No. 10. “Special Needs Populations: Perioperative Care of the Patient with Creutzfield-Jakob Disease.” Mark Karasin, BSN, BA, RN. Quote reference WHO Infection Control ITEM # & DESCRIPTION QTY PR.54-500 •Hudson Brace •Jansen Bayonet Forcep 7in • McKenzie Enlarging Bur 16mm • Insulated Bipolar Bayonet Forcep 7in •Foerster Sponge Forcep • Frazier Suction 10fr • Metzenbaum Scissors 7in Curved • Frazier Suction 12fr •Mayo Scissors 6.75in straight • Freer Elevator •(4) Halstead-Mosquito Forceps Curved • Gigli Wire Saw 12in • Gigli Wire Saw Handles (set of 2) TOTAL ITEMS REQUESTED: Please email your form to: [email protected] COMMENTS: 6.
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