PRIORITY: ***EMERGENCY*** Accepted by eCMS JAN 09, 2018@06:56:34 693-18-2-135-0355 -------------------------------------------------------------------------------- REQUEST, TURN-IN, AND RECEIPT FOR PROPERTY OR SERVICES -------------------------------------------------------------------------------- TO: A&MM Officer Requesting Office SURGICAL SERVICE (112) ----------------------- -------------------------------------------------------- Action Requested Date Prepared Date Required Delivery JAN 04, 2018 JAN 10, 2018 ----------------------- --------------------- ---------------------------------- ITEM NO. DESCRIPTION QUANTITY UNIT ESTIMATED OR STOCK NO. UNIT COST -------------------------------------------------------------------------------- INSTRUMENTS: 01.212.007 1 ITEM ID NO. 48889 SET,INST/IMPLANT,SM FRAGMENT LCP, WITH 4.0MM CANNULATED SCREWS: 6 3.5MM CORTEX SCREW SELF-TAPPING 10MM 6 3.5MM CORTEX SCREW SELF-TAPPING 12MM 6 3.5MM CORTEX SCREW SELF-TAPPING 14MM 6 3.5MM CORTEX SCREW SELF-TAPPING 16MM 6 3.5MM CORTEX SCREW SELF-TAPPING 18MM 6 3.5MM CORTEX SCREW SELF-TAPPING 20MM 6 3.5MM CORTEX SCREW SELF-TAPPING 22MM 6 3.5MM CORTEX SCREW SELF-TAPPING 24MM 6 3.5MM CORTEX SCREW SELF-TAPPING 26MM 6 3.5MM CORTEX SCREW SELF-TAPPING 28MM 6 3.5MM CORTEX SCREW SELF-TAPPING 30MM 6 3.5MM CORTEX SCREW SELF-TAPPING 32MM 6 3.5MM CORTEX SCREW SELF-TAPPING 34MM 6 3.5MM CORTEX SCREW SELF-TAPPING 36MM 6 3.5MM CORTEX SCREW SELF-TAPPING 38MM 6 3.5MM CORTEX SCREW SELF-TAPPING 40MM 6 3.5MM CORTEX SCREW SELF-TAPPING 50MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/22MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/24MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/26MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/28MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/30MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/40MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/45MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/10MM . 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/12MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/14MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/16MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/18MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/20MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/22MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/24MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/26MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/28MM 4 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/40MM 4 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/45MM 2 4.0MM CANNULATED SCREW SHORT THREAD/10MM 2 4.0MM CANNULATED SCREW SHORT THREAD/12MM 2 4.0MM CANNULATED SCREW SHORT THREAD/14MM 2 4.0MM CANNULATED SCREW SHORT THREAD/16MM 2 4.0MM CANNULATED SCREW SHORT THREAD/18MM 2 4.0MM CANNULATED SCREW SHORT THREAD/20MM 2 4.0MM CANNULATED SCREW SHORT THREAD/22MM 2 4.0MM CANNULATED SCREW SHORT THREAD/24MM 2 4.0MM CANNULATED SCREW SHORT THREAD/26MM 2 4.0MM CANNULATED SCREW SHORT THREAD/28MM 2 4.0MM CANNULATED SCREW SHORT THREAD/30MM 2 4.0MM CANNULATED SCREW SHORT THREAD/32MM 2 4.0MM CANNULATED SCREW SHORT THREAD/34MM 2 4.0MM CANNULATED SCREW SHORT THREAD/36MM 2 4.0MM CANNULATED SCREW SHORT THREAD/38MM 2 4.0MM CANNULATED SCREW SHORT THREAD/40MM 2 4.0MM CANNULATED SCREW SHORT THREAD/42MM 2 4.0MM CANNULATED SCREW SHORT THREAD/44MM 2 4.0MM CANNULATED SCREW SHORT THREAD/46MM 2 4.0MM CANNULATED SCREW SHORT THREAD/48MM 2 4.0MM CANNULATED SCREW SHORT THREAD/50MM 6 WASHER 7.0MM 2 3.5MM LCP PLATE 5 HOLES 72MM 2 3.5MM LCP PLATE 6 HOLES 85MM 2 3.5MM LCP PLATE 8 HOLES 111MM 2 3.5MM LCP PLATE 9 HOLES 124MM 2 3.5MM LCP PLATE 10 HOLES 137MM 2 3.5MM LCP PLATE 12 HOLES 163MM 2 3.5MM LCP PLATE 14 HOLES 189MM 1 3.5MM LCP T-PLATE 3H HEAD/ 3H SHAFT/52MM-OBLIQUE RIGHT 1 3.5MM LCP T-PLATE 3H HEAD/ 4H SHAFT/63MM-OBLIQUE RIGHT 1 3.5MM LCP T-PLATE 3H HEAD/ 5H SHAFT/74MM-OBLIQUE RIGHT 1 3.5MM LCP T-PLATE 3H HEAD/ 7H SHAFT/96MM-OBLIQUE RIGHT 1 3.5MM LCP T-PLATE 3H HEAD/ 3H SHAFT/50MM-RIGHT ANGLE 1 3.5MM LCP T-PLATE 4H HEAD/ 4H SHAFT/56MM-RIGHT ANGLE 1 3.5MM LCP T-PLATE 3H HEAD/ 5H SHAFT/67MM-RIGHT ANGLE 1 3.5MM LCP T-PLATE 4H HEAD/ 6H SHAFT/78MM-RIGHT ANGLE 1 3.5MM LCP T-PLATE 3H HEAD/ 7H SHAFT/87MM-RIGHT ANGLE 2 LCP ONE-THIRD TUBULAR PLATE WITH COLLAR 5 HOLES/57MM 2 LCP ONE-THIRD TUBULAR PLATE WITH COLLAR 6 HOLES/69MM 2 LCP ONE-THIRD TUBULAR PLATE WITH COLLAR 7 HOLES/81MM 2 LCP ONE-THIRD TUBULAR PLATE WITH COLLAR 8 HOLES/93MM 1 LCP ONE-THIRD TUBULAR PLATE WITH COLLAR 10HOLES/117MM 1 LCP ONE-THIRD TUBULAR PLATE WITH COLLAR 12HOLES/141MM 1 3.5MM LCPr PROXIMAL HUMERUS PLATE-STANDARD 3H SHAFT/90MM 1 3.5MM LCPr PROXIMAL HUMERUS PLATE-STANDARD 5H SHAFT/114MM 1 3.5MM LCP T-PLATE 3H HEAD/ 3H SHAFT/52MM-OBLIQUE LEFT 1 3.5MM LCP T-PLATE 3H HEAD/ 4H SHAFT/63MM-OBLIQUE LEFT 1 3.5MM LCP T-PLATE 3H HEAD/ 5H SHAFT/74MM-OBLIQUE LEFT 1 3.5MM LCP T-PLATE 3H HEAD/ 7H SHAFT/96MM-OBLIQUE LEFT 1 3.5MM LCP RECONSTRUCTION PLATE 5 HOLES/70MM 1 3.5MM LCP RECONSTRUCTION PLATE 6 HOLES/84MM 1 3.5MM LCP RECONSTRUCTION PLATE 7 HOLES/98MM 1 3.5MM LCP RECONSTRUCTION PLATE 8 HOLES/112MM 1 3.5MM LCP RECONSTRUCTION PLATE 10 HOLES/140MM 1 3.5MM LCP RECONSTRUCTION PLATE 12 HOLES/168MM 1 1.25MM KIRSCHNER WIRE W/TROCAR POINT 150MM 1 2.0 MM KIRSCHNER WIRE W/TROCAR POINT 150MM 1 1.6 MM KIRSCHNER WIRE WITH 5MM THREAD-TROCAR POINT 150MM 2 2.0MM DRILL BIT/QC/125MM 2 2.5MM DRILL BIT/QC/GOLD/110MM 2 2.8MM DRILL BIT/QC/165MM 2 3.5MM DRILL BIT/QC/110MM 1 COUNTERSINK F/3.5MM CORTEX & 4.0MM CANCELLOUS BONE SCREWS 2 TAP FOR 3.5MM CORTEX SCREWS GOLD/110MM 2 TAP FOR 4.0MM CANCELLOUS BONE SCREWS/110MM 1 HANDLE WITH QUICK COUPLING, SMALL 1 2.0MM PARALLEL DRILL GUIDE AND DRILL SLEEVE 1 3.5MM/2.5MM INSERT DRILL SLEEVE 4 2.8MM THREADED DRILL GUIDE 1 SMALL HEXAGONAL SCREWDRIVER WITH HOLDING SLEEVE 1 SMALL HEXAGONAL SCREWDRIVER SHAFT 1 STARDRIVE(TM) SCREWDRIVER T15 1 STARDRIVE SCREWDRIVER SHAFT QC/T15 2 2.7MM THREE-FLUTED DRILL BIT QC/125MM 1 DEPTH GAUGE FOR 2.7MM & SMALL SCREWS 1 SHARP HOOK 1 SCREW FORCEPS 2 1.6MM WIRE SLEEVE 1 DIRECT MEASURING DEVICE 1 INSERTION GUIDE 2 3.5MM LOCKING SCREW SLEEVE 2 2.8MM DRILL SLEEVE 2 1.6MM WIRE SLEEVE 1 2.7MM UNIVERSAL DRILL GUIDE 1 3.5MM UNIVERSAL DRILL GUIDE 1 THREADED PLATE HOLDER 1 PUSH-PULL REDUCTION DEVICE 1 THREADED PLATE HOLDER-LONG FOR 3.5MM LOCKING HOLE 1 BENDING IRON FOR 2.7MM & 3.5MM PLATES 1 BENDING IRON FOR 2.7MM & 3.5MM PLATES 2 BENDING IRON FOR 2.7MM & 3.5MM RECONSTRUCTION PLATES 1 BENDING TEMPLATE 12H FOR 3.5MM LC-DCPr & DCPr & LCP PLATES 1 BENDING TEMPLATE 7 HOLES FOR 3.5MM LC-DCP & DCPr PLATES 1 BENDING TEMPLATE 9 HOLES FOR 3.5MM LC-DCPr & DCPr PLATES 1 WIRE-BENDING PLIERS 160MM 1 BENDING IRON FOR 1.25MM, 1.6MM & 2.0MM KIRSCHNER WIRES 1 REDUCTION FORCEPS WITH POINTS NARROW-RATCHET 132MM 1 REDUCTION FORCEPS WITH POINTS BROAD-RATCHET 1 PLATE HOLDING FORCEPS WITH SWIVEL FOOT/SIZE 0 1 BONE HOLDING FORCEPS-SOFT RATCHET F/PLATES TO 9MM WIDE 2 SMALL HOHMANN RETRACTOR 8MM SHORT NARROW TIP 160MM 1 PERIOSTEAL ELEVATOR 6MM CURVED BLADE-ROUND EDGE 2 HOHMANN RETRACTOR 15MM 160MM 2 REDUCTION FORCEPS WITH SERRATED JAW-RATCHET 144MM 1 TORQUE LIMITING ATTACHMENT 1.5NM/QUICK COUPLING 1 2.7MM CANNULATED DRILL BIT/QC 160MM 1 CANNULATED COUNTERSINK F/3.5MM & 4.0MM CANNULATED SCREWS 1 CANNULATED TAP FOR 4.0MM CANNULATED SCREWS/147MM 1 2.7MM/1.25MM DOUBLE DRILL SLEEVE 1 HOLDING SLEEVE 1 CANNULATED 2.5MM HEXAGONAL SCREWDRIVER 1 CANNULATED SCREW MEASURING DEVICE FOR 3.5MM & 4.0MM 1 1.35MM CLEANING BRUSH 1 1.25MM CLEANING STYLET 201.25MM THREADED GUIDE WIRE 150MM 2 2.7MM CORTEX SCREW SELF-TAPPING 10MM 2 2.7MM CORTEX SCREW SELF-TAPPING 12MM 4 2.7MM CORTEX SCREW SELF-TAPPING 14MM 4 2.7MM CORTEX SCREW SELF-TAPPING 16MM 4 2.7MM CORTEX SCREW SELF-TAPPING 18MM 4 2.7MM CORTEX SCREW SELF-TAPPING 20MM 2 2.7MM CORTEX SCREW SELF-TAPPING 22MM 2 2.7MM CORTEX SCREW SELF-TAPPING 24MM 2 2.7MM CORTEX SCREW SELF-TAPPING 26MM 2 2.7MM CORTEX SCREW SELF-TAPPING 28MM 2 2.7MM CORTEX SCREW SELF-TAPPING 30MM 2 2.7MM CORTEX SCREW SELF-TAPPING 32MM 2 2.7MM CORTEX SCREW SELF-TAPPING 34MM 2 2.7MM CORTEX SCREW SELF-TAPPING 36MM 2 2.7MM CORTEX SCREW SELF-TAPPING 38MM 2 2.7MM CORTEX SCREW SELF-TAPPING 40MM 2 2.7MM CORTEX SCREW SELF-TAPPING 45MM 2 2.7MM CORTEX SCREW SELF-TAPPING 50MM 2 2.7MM CORTEX SCREW SELF-TAPPING 55MM 6 3.5MM CORTEX SCREW SELF-TAPPING 42MM 6 3.5MM CORTEX SCREW SELF-TAPPING 44MM 6 3.5MM CORTEX SCREW SELF-TAPPING 46MM 6 3.5MM CORTEX SCREW SELF-TAPPING 48MM 2 4.0MM CANCELLOUS BONE SCREW FULL THREADED/14MM 3 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/16MM 3 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/18MM 4 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/20MM 2 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/35MM 2 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/50MM 2 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/55MM 2 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/60MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/30MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/35MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/50MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM)RECESS 10MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS12MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/55MM 2 4.0MM CANCELLOUS BONE SCREW PARTIALLY THREADED/60MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 52MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 56MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 58MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 60MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 64MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 68MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 72MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 14MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 16MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 18MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 20MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 22MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 24MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 26MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 28MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 30MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 32MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 34MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 36MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 38MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 40MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 50MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE(TM) RECESS 60MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE RECESS 42MM 6 3.5MM LOCKING SCREW SLF-TPNG WITH STARDRIVE RECESS 44MM 6 3.5MM LOCKING SCREW SLF-TPNG WITH STARDRIVE RECESS 46MM 6 3.5MM LOCKING SCREW SLF-TPNG W/STARDRIVE RECESS 48MM 6 3.5MM LOCKING SCREW SLF-TPNG WITH STARDRIVE RECESS 52MM 6 3.5MM LOCKING SCREW SLF-TPNG WITH STARDRIVE RECESS 54MM 5 3.5MM LOCKING SCREW SLF-TPNG WITH STARDRIVE RECESS 56MM 5 3.5MM LOCKING SCREW SLF-TPNG WITH STARDRIVE RECESS 58MM 2 4.0MM CANNULATED SCREW-SHORT THREAD 54MM 6 3.5MM CORTEX SCREW SELF-TAPPING 55MM 6 3.5MM CORTEX SCREW SELF-TAPPING 60MM 2 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/10MM 2 4.0MM CANCELLOUS BONE SCREW FULLY THREADED/12MM 1 SM FRAG LCP INSTR/IMPL SET GRAPHIC CASE W/O SCR RACK 1 SMALL FRAGMENT LCPr CANNULATED SCREW RACK 1 SMALL FRAGMENT LCPr CANNULATED SCREW INSTRUMENT TRAY PKG: 1 per SE eCMS Item Line ID 12954293

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