Urine Drug, Alcohol and Cotinine Screen
Date of sample taken
date
Time of sample taken
time
Mark appropriate box(es):
text
Cocaine
text
Amphetamines
text
Benzodiazepines
text
Cannabinoids
text
Opiates
text
Barbiturates
text
Alcohol
text
Cotinine
text
If any of the above are positive, exclude subject from the study.
text
Vital Signs