INSULIN PUMP CONSUMABLES ORDER FORM - NDSS
INSULIN PUMP CONSUMABLES ORDER FORM - NDSS
INSULIN PUMP CONSUMABLES ORDER FORM - NDSS
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<strong>NDSS</strong> IPC Order Form continued<br />
Pump Reservoirs/Cartridges<br />
701 Animas IR1000 3mL AMSL 100-052-01 IR1000 na na 10 10.00<br />
702 Deltec Insulin Reservoir, 3mL MSA 21-1750-24 Cozmo na na 25 24.60<br />
704 Minimed Reservoir, 3mL Medtronic MMT-103A 507/507 c/508 na na 10 10.00<br />
705 Medtronic Paradigm Insulin Reservoir 1.8mL Medtronic MMT-326A 515/522/554 na na 10 10.00<br />
706 Medtronic Paradigm Insulin Reservoir 3mL Medtronic MMT-332A 715/722/754 na na 10 10.00<br />
709.1 Dana Reservoir 3mL Manage DAC00201 Dana only na na 10 10.00<br />
710 Animas IR1200/2020 Pump Cartridge 2mL AMSL AN100-124-01 IR1200 / 2020 na na 10 10.00<br />
711 Universal Reservoir 1.8mL MSA 1850-326A Universal na na 10 10.00<br />
712 Universal Reservoir 3.0mL MSA 3070-332A Universal na na 10 10.00<br />
713 Accu-Chek Spirit Cartridge 3.15mL Roche 5206073001 Spirit/ H-TRONplus na na 25 24.60<br />
714 Accu-Chek Spirit Cartridge 3.15mL Roche 4949935001 Spirit/ H-TRONplus na na 5 5.00<br />
Subtotal (C) $<br />
Total Amount Payable<br />
(A+B+C)<br />
$<br />
Office Use Only<br />
1 This column indicates manufacturer recommended pump for use with listed consumable.<br />
2 If a 'Lure lock' connection type is indicated, the product may be compatible with other pumps. Please note that the pump manufacturer may decline to provide support (or honour warranties) in the event that problems arise while utilising a pump<br />
3 'sets' indicates equal number of cannulae and lines, e.g. '10 sets' = 10 cannulae + 10 lines.<br />
4 Please note that there are no additional concessions on subsidised insulin pump consumables.<br />
# Inset products include an additional co-payment of $20.00 per box to fund the integrated inserter.<br />
Supplier codes:<br />
AMSL - Australasian Medical & Scientific Limited<br />
Medtronic - Medtronic Australasia<br />
Manage - Managing Diabetes<br />
Roche - Roche Diagnostics<br />
Needle/cannula angle & type: straight, metal = sm straight, Teflon = sT angled, metal = am angled, Teflon = aT<br />
The National Diabetes Services Scheme (<strong>NDSS</strong>) is an initiative of the Australian Government administered by Diabetes Australia<br />
OPS.FM.RG.014 v1206<br />
<strong>NDSS</strong> <strong>ORDER</strong> <strong>FORM</strong> - UPDATED 01/06/2012
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