Urine Toxicology Collection
Printable Instructions PDF
- Specimen Collection:
- Use collection cups provided for urine specimen collection.
- Ensure the cap is closed tightly and locked.
- Place sticker provided on top of requisition form on cup to create a second form of seal on cup.
- Requisition Forms:
- Patient FIRST and LAST name
- Patient DOB
- Patient GENDER
- Collection DATE, TIME and INITIAL of collector
- PANEL Doctor ordered is checked off
- DIAGNOSIS CODES must all be checked off
- In section A. QUANTITATIVE BASELINE TESTING, check off “Test Entire Group” for all three boxes
- Natural and Semi-Synthetic Opioids, Illicits, and Benzodiazepines
- In section B. SELECT DRUGS FOR CONFRIMATION TESTING, check off “Test Entire Group” for synthetic opioids, barbituates, muscle relaxants anti-convulsants, and stimulants.
- For OTHER, check off both alcohol and cotinine.
- Current Medications are preferred but not required
- PATIENT SIGNATURE
- DOCTOR/PRESCRIBER SIGNATURE
- Additional Forms:
- Patient Valid INSURANCE (front and back).
- Patient VALID ID (includes patient’s billing address).
- ASSIGNMENT OF BENENFITS (AOB) form signed by patient (Most important with Blue Cross/Shield).
- WORKERS COMPENSATION INS FORMS (if applicable)
- Include claim number for each Incident.
- Attorney/Adjuster Name and Phone number.
DID ALL THE ABOVE AND READY TO SEND IN YOUR SAMPLE??
- Place the sealed collection cup in the specimen collection bag and seal the top.
- Place the completed white copy of requisition form, copy of Patient ID, Insurance and signed AOB form in side pocket of specimen bag.
- Place the prepared specimen bag(s) in the UPS bag provided to ship samples. Seal the UPS bag (Pak).
- Drop off at your nearest UPS shipping center or simply wait for UPS to pick up (must be scheduled in advance)
Blood Work Collection