Toxicology Order Sheet

Submitted by Admin on Mon, 2010-12-06 16:17

Forensic Toxicology Client Supply Form

Source Facility #: *

Date: *

Client Name: *

Requested By: *

Client Address: *

Email:

City: *

State: *

Zip: *

Phone: *

Fax: *

If Ship-to is different than above, complete information below

Ship To Name:

Ship To Address:

Ship To City:

Ship To State:

Ship To Zip:

Ship To Phone:

Ship To Fax:

Chain of Custody Forms

15181-DHHS-QTY:

15180-SAFE-QTY:

RD NAME & # (if different from above):

MRO:

Collection Site

Collection Name:

Collection Address:

Collection City:

Collection State:

Collection Zip:

Collection Phone:

Collection Fax:

Collection Kits

Collection Kit (single bag) 14485 EA:

Collection Kit (single bag with mailer) 14486 EA:

Collection Kit (split bag with mailer) 14487 EA:

Collection Kit (split bag without mailer) 14488 EA:

Quantisal Kits 16379 EA:

Printer or Paper Supplies

Laser Toner Cartridge 14680 EA:

Printer Ribbon Okidata 320 14727 EA:

Shipping Supplies

Box Liner 33 x 39 15354 EA:

Security Bags 14484 EA:

5 x 5 x 5 box 15328 EA:

12 x 12 x 4 box 15329 EA:

12 x 12 x 12 box 15326 EA:

16 x 16 x 12 box 15324 EA:

Air Bills & Lab Packs

FED EX Air Bills 15930 EA:

FED EX Lab Packs 15931 EA:

UPS Labels: