200 Precision Rd, Ste 200 Horsham, PA 19044
P 800.235.4890 F 888.488.8874
Supply Order Request
SPECIMEN COLLECTION AND SHIPPING INFORMATION Shipping is simple. DRUGSCAN ® provides clinical paks, shipping boxes, and overnight shipping labels. As per Section 1, shipping supplies can be ordered by phone, fax, email, or by contacting your DRUGSCAN ® account executive. Please Note: Unless another method is requested and approved, all supplies will be sent via ground shipping. Please allow 3-5 days for delivery of shipping supplies, including return labels Routine Pickup If you select a regularly scheduled specimen pickup, FedEx or UPS will be contacted on your behalf to arrange a time and date. It may take up to 48 hours for routine pickup to begin. If you need a pickup prior to 48 hours, wish to schedule an additional pickup, or make a change to the existing schedule, please call DRUGSCAN ® customer service at 800.235.4890. Please circle your scheduled pickup day(s) and indicate time:
QUANTITY
ITEM
Requisition Forms with panel number:
Snap down specimen kit (cup with bag)
White screw top specimen cup
Oral fluid collection device
Specimen bag – standard
Urine collection pan
DRUGSCAN shipping boxes
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Clinical Paks
Preprinted Air Bills
Pick up time:
Does your office utilize FedEx or UPS? _________________
PrN (As Needed) Pickup If you select as needed specimen pickup, please contact DRUGSCAN ® customer service at 800.235.4890 and provide the customer service representative with the tracking number located on the bottom of the shipping label. Please note shipping providers usually require at least 3 hours of notice and provide a 2 hour window for pickup. If you need assistance or have a problem, please call DRUGSCAN ® customer service. When packaging specimens for shipment: • Use only DRUGSCAN ® supplied clinical shipping boxes • Make sure all collection devices are sealed properly to protect specimens during transport .
Requester’s Name: __________________________________
Date: _________________
Account Number: __________________________________________________________________
Address: __________________________________________________________________________
Phone: ___________________________________________________________________________
Please fax completed form to DRUGSCAN customer service at 888.488.8874 or email to DRUGSCAN Customer Service at customerservice @ DRUGSCAN.com
5 800.235.4890 | drugscan.com | customerservice @ DRUGSCAN.com
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