Authorization Form

REGISTRATION NUMBER: 476701507

Order Expiration Date/Time: Authorization Barcode #:

08/10/2023 06:00:00 PM CST: 5-Panel Urine 476701507

Employer/Contractor Information: Medical Review Officer/Managed Service Provider:

JB Hunt - Best Buy Program Thereza Tosado, MD
615 J B Hunt Corporate Drive Medical Review Office
Lowell, AR 72745 2275 S Babcock Street
Phone: 8007231939 Fax: 1111111111 Melbourne, FL 32901

Phone#: 321-821-3383 Fax#: 321-216-3155

Test Information
Donor Information Test Details
Name: Javier Reason For Test: Pre-Employment
Lara Vargas Account: 03523440
ID: *****1270
Home Phone: 346-779-3421
Work Phone: 346-779-3421
Service(s) to be Performed
Service Laboratory Laboratory Test
5-Panel Urine LABCORP 790197

Collection Site Information

LABCORP
1331 W GRAND PARKWAY N, SUITE 160
KATY TX 77493
Phone#: (281)574-4574
Hours: M-F 08:30A-03:30P

Alternate Collection Sites

Site Name Site Address Site Phone Site Hours Miles Map
LABCORP 19002 PARK ROW, 281-957-3639 M-F 8AM CLOSED - 5PM 12PM-1PM 10.04 View
SUITE 106
HOUSTON, TX 77084
LABCORP 11301 FALLBROOK, 281-955-7356 M-F 7:30am-4:30pm 14.64 View
SUITE 126
HOUSTON, TX 77065
LABCORP 7207 GESSNER DR 713-561-4453 M-F 8:00am-3:30pm Closed Lunch 12:30pm-1:30pm CLOSED 14.83 View
HOUSTON, TX 77040
LABCORP 21216 NW FRWY 200 281-653-7849 M-F 8:00am-4:00pm 14.99 View
CYPRESS, TX 77429
LABCORP 1601 MAIN ST STE 405 281-341-9316 M-F 7:30am-4:00pm Closed Lunch 12:00pm-1:30pm 15.58 View
RICHMOND, TX 77469

Please bring your government issued photo-ID for identification at the collection facility.
You must bring this authorization form to the collection facility.