Non-Regulated Drug Test Custody and Control Form
Please complete the Non-Regulated Drug Test Custody and Control Form to document the chain of custody and relevant details for this non-regulated drug test. Do not provide any sensitive health or confidential information.
Donor Name
*
First Name
Last Name
Date of Collection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Specimen ID Number
*
Collection Site
*
Test Type
*
Please Select
Urine
Saliva
Hair
Other
Collector Name
*
First Name
Last Name
Witness Name (if applicable)
First Name
Last Name
Comments or Notes
Donor Acknowledgment Signature
*
Collector Acknowledgment Signature
*
Submit Form
Submit Form
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