Outreach Services - Stock Request Form Appendix D Name of Outreach Service Name of Person Requesting supplies Date Address Tel: Email: Requested Collection Date (please allow up to 7 days for collection of non-clinical supplies clinical supplies will be delivered direct) – Item Quantity Case Qty Part code CLINICAL EXS Regular Condoms 144 EXSREG-144 EXS Extra Condoms 144 EXSEXTSA EXS Mixed Flavour Condoms 144 EXSMIXED-144 Mates Skyn Condoms (latex-free) 72 MTSKYN72 EXS Clear Paraben free Lube 5ml sachets 100 EXSCLEARSACH Mixed Flavour Dams 36 DENTALDAMLATEX Pregnancy Test Dip and Read 50 LTCPREGSTRIP Urine Bottles 30 UNIVERSAL30ML NON CLINICAL Sexual Health Sheffield information credit cards Youth Clinic Cards Fast Track/Star Cards Max 30 Postal Chlamydia/Gonorrhoea kits Other sexual health leaflets order – Please email to: sexualhealthadmin@sth.nhs.uk
Appendix D Outreach Services - Stock Request Form Name of Outreach Service Name of Person Requesting supplies Date Address Tel: Email: Requested Collection Date (please allow up to 7 days for collection of non-clinical supplies – clinical supplies will be delivered direct) Item Quantity Case Qty Part code CLINICAL EXS Regular Condoms 144 EXSREG-144 EXS Extra Condoms 144 EXSEXTSA EXS Mixed Flavour Condoms 144 EXSMIXED-144 Mates Skyn Condoms (latex-free) 72 MTSKYN72 EXS Clear Paraben free Lube 5ml sachets 100 EXSCLEARSACH Mixed Flavour Dams 36 DENTALDAMLATEX Pregnancy Test Dip and Read 50 LTCPREGSTRIP Urine Bottles 30 UNIVERSAL30ML NON CLINICAL Sexual Health Sheffield information credit cards Youth Clinic Cards Fast Track/Star Cards Max 30 Postal Chlamydia/Gonorrhoea kits Other sexual health leaflets – order Please email to: sexualhealthadmin@sth.nhs.uk
Open-Doors-Guidelines-2017.docx