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Submit by Email Print Form URINE INITIAL DRUG SCREEN RESULT FORM TM Specimen ID Number STEP 1 COMPLETED BY COLLECTOR OR EMPLOYER REPRESENTATIVE COLLECTION SITE / COMPANY NAME ADDRESS SUITE CITY STATE PHONE FAX POSTAL CODE DONOR SSN DRIVER S LICENSE or EMPLOYEE I. D. NO. ID VERIFIED BY PHOTO ID q DONOR NAME Last REASON FOR TEST COLLECTOR NAME EMPLOYER REP. q First Pre Employment Random Reasonable Suspicion / Cause Post Accident Return to Duty PRINT Read specimen temperature within 4 minutes....
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