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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 POSTAL CODE FAX 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 q Random q Reasonable Suspicion / Cause q Post Accident q...
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