Forensic Drug Testing

Authorization Form
Order Expiration Date / Time: 06/15/2011 05:00 PM EST
Authorization Barcode #: 2409733

Preferred Schedule Date / Time: 06/14/2011 09:00 AM EST

Employer Information: CSC - ATS SAGAYARAJ AROKIA 32605 WEST 12 MILE RD#250 FARMINTON HILLS, MI 48334 Phone#: (248)592-5732 Medical Review Officer/Managed Service Provider: EMRO-DR STEVE KRACHT 7500 W 110TH ST STE 500 PO BOX 25903 OVERLAND PARK,KS 66225 Phone#: (888)382-2281 Fax#: (913)469-4029

Test Information
Donor Information Name: Abhilasha Maity ID: *****8432 Daytime Phone: (704)905-8571 Evening Phone: (704)905-8571 Test Details Reason For Test: PRE-EMPLOYMENT - 1 Account: 10083274

Service(s) to be Performed
Service Split Urine Laboratory Quest Diagnostics Laboratory Test (6405N) SAP 5-50 GC/MS