Drug Screening ServiceBill Employee Bill I.C.Please check off service (s) needed for this appointment.Use of this form requires an established account with an Individual Client Number. If you do not have an active I.C. number, please contact us by calling +410-417-7443Company Name:I.C.:Employee Name:DOB: Last 4 Digits of SS: Paramedical Testing requires a Doctor’s Order: DOT (5-Panel) Urine Non-DOT (10-Panel) Urine Non-DOT (10-Panel) Urine with Alcohol Instant Drug Screen (13-Panel) Urine Blood Alcohol Level (BAC)- (Requires a Doctor’s Order)Submit Form
