Collection Requirements

ONLY AVAILABLE FOR CLIENT HOSPITALS***

If used for pre-employment screening or other legal reasons, a Medtox chain of custody form must be filled out completely. Step 1: If the information in STEP 1 has not been completed, collector/donor completes STEP 1, including the donor consent. Then check the appropriate box below the test(s) ordered section. Ensure donor provides his/her daytime phone #.

Step 2: Indicate reason for the test – Check the appropriate box.

Step 3: Upon receiving the specimen from donor, check specimen temperature. This must be accomplished within 4 minutes. Check box marked “Yes” if temperature is within range. If specimen temperature is not within range, check block marked “No,” and complete remarks section.

Step 4: Secure cap on specimen bottle (containing at least 30 mL of urine) and affix specimen bottle seal labeled A over the cap and down the sides of the specimen bottle. Make sure the bottle is closed securely. Record date on specimen bottle seal. Instruct donor to initial the specimen bottle seal. Complete STEP 4 with the name and address of the facility at which the collection is taking place. List a business telephone number and fax where collector can be reached. Record any unusual occurrences concerning the collection (e.g. donor refusal to provide information/sign certification statement, specimen collected under direct observation, suspected adulteration) in the remarks section. Record date and time of collection. Print and sign name as collector.

*This constitutes the external chain of custody. Sample cannot be processed if this section is not completed properly.