Urine Drug Testing Checklist

    • Please clearly fill out patient information on the requisition form
    • Please provide full insurance information (copy of the insurance card is best)
    • Please fill in the temperature, time and date the specimen was collected, and initial
    • Please check off prescribed medications the patient is currently taking
    • Please check off any preliminary positive or negative POC results (located on the right hand side of the requisition form)
    • Please provide the appropriate ICD-10 diagnosis code
        • Z79.891 Long term (current) use of opiates
        • Z79.899 Other long Term (current) drug therapy
        • Z51.81 Encounter for therapeutic drug level monitoring
    • Please have patient and physician sign the form
    • Please place specimen cup in the specimen bag with the white copy of the requisition form and insurance information in the outside slot (keep a copy of the form for your records)
    • Please call our office at (201) 884-9160 for pickup before 5pm
    • For UPS pickup please call 1-800-742-5877
    • For FedEx pickup please call 1-800-463-3339
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