Specimen Collection

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

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