DRUG SCREENING INFORMATION
You will need a drug screen. This must be done at CCom, (Any Location)
CCom, Sisters Grove Pavilion,
6011 E. Woodman #100,
Colorado Springs, CO 80923
Phone 719-571-8888
Or
CCom, Audubon Building,
3030 N. Circle Dr. Suite #210,
Colorado Springs 80904
Phone 719 -776-4800
Or
Denver Locations
St. Anthony North CCom
8510 Bryant St. Suite 360
Westminster, CO 80031
(303)650-7973
Or
Littleton CCom
20 West Dry Creek Circle
Littleton, CO 80122
(303)269-2900
The cost is $ 45.00 and you must have exact change or a credit card. Before you go, complete the
Authorization Form and bring it to CCOM. The results will be reported via a secure PDF form to Jackie
Berning, Department Chair of Beth-El College of Nursing and Health Sciences. You must pass the drug screen
to be allowed to go to clinical.
Should there be a negative finding, the designee will forward required information to Jackie Berning,
Department Chair of Beth-El College of Nursing and Health Sciences, for review. Eligibility is based on the
nature of the findings, as well as clinical site requirements.
Deadline for completion is January 14, 2014
BETH-EL NURSING and HEALTH SCIENCE STUDENTS
AUTHORIZATION FORM FOR DRUG/ALCOHOL TESTING
Collection Site: Colorado Springs: CCOM, Sisters Grove Pavilion, 6011 E. Woodman
#100, Colorado Springs, CO 80923
Suite 3210
or
CCOM Audubon Building 3030 N. Circle Dr.
Applicant’s Name:
(First)
(Middle)
(Last)
Applicant’s SSN#:
Applicant home phone w/area code:
TYPE OF TEST:
Six panel Drug Screen
X Pre-clinical __ Reasonable Suspicion
__ Follow up
Date/Time Notified of Test:
Requested by: Jackie Berning, Department Chair Beth-El College of Nursing
and Health Sciences
Phone #: 255-3078
Collection Site: Please bring this completed form to: Maggie Hirsch 9-5
M-F
Questions, please call Maggie Hirsch at CCOM