Southern Health Order Form

Southern Health

Hospital/Site Name:


Telephone Number:

Email Address:

Contact Name:

Special Instructions:

Fax Number:



Bag Seal/Tag ONLY (No contents used)

Oxygen Cylinder Refill

Non-rebreath Oxygen Mask

NaCL 500ml 0.9 Sodium Chloride

Adrenaline 1:10,000 Prefilled Syringe

Adrenaline 1:1,000 AMPS

Amiodarone 300mg Injection

Chlorphenamine Injection


Salbutamol Inhaler

Salbutamol 5mg Nebuliser Solution

Nebulizer Mask

Ipratropium Bromide 500mcg Nebuliser Solution

GTN Spray

Box Furosemide Ampoules 20mg

Box Aspirin 300mg

Glucagon 1mg

Box of Glucogel

Flumazenil Amps (500mcg/5ml)

Box of Naloxone 400mcg/1ml Ampoules

Disposable Tourniquet

Intravenous Infusion Set

Double Lumen IV Extension Set

Saline Flush PFS

Adhesive Tape - Micropore 2.5cm Roll

Dressings Pads (Non Stock Sterile Gauze)

2% Chlorhexidine Alcohol Wipes

Ampoule Breakers

IV Cannula Dressings

Drawing Up Needle

5ML Syringe

2ML Syringe

1ML Syringe

Gauze Swab

Ligature Pack


CPR Mask in Hard Case

Disposable Gloves - Med/Large

Safety Goggles

Polythene Apron - White



Adult BVM

Child BVM

Zoll AED Pro

Set Zoll CPR Pads

3 Lead ECG Cable

Set ECG Dots

Zoll AED Pro Battery

Ready Pack in Clear Bag


Nasopharyngeal Airway Size 6

Nasopharyngeal Airway Size 7

Guedal Airway Size 2 (Green)

Guedal Airway Size 3 (Orange)

Guedal Airway Size 4 (Red)

Magill forceps (8" Adult size)

I-gel Airway (Size 3)

I-gel Airway (Size 4)

Igel Airway (Size 5)

Lube Sachet

Portable Suction Unit

Stethoscope - Dual Head

Blood Glucose Testing Kit

Pack Blood Glucose Testing Strips

Pen Torch

Pulse Oximeter - Fingertip


Manual Blood Pressure Cuff - Small

Manual Blood Pressure Cuff - Medium

Manual Blood Pressure Cuff - Large

Manual Blood Pressure Cuff - X Large

Sharps Bin

Clinical Waste Bag (Single)

21 Gauge Needle

23 Gauge Needle

Aerochamber Plus Device

16G Grey IV Cannula

18G Green IV Cannula

20G Pink IV Cannula