DRUG AND ALCOHOL
TESTING REPORT
CDL/Issuing State
Gaylord, Lauren
Patient
CCF / Accession #:
Patient Paid
Company
6105238
02/08/2022
Collection Date
COLLECTION SITE
LABORATORY
Quest Diagnostics-Lenexa
10101 Renner Blvd
Lenexa, KS 66219
Texas MedClinic
12319 North Mopac Expressway
Austin, TX 78758
(512) 835-5577 Fax (512) 836-0166
PURPOSE OF TEST :
02/14/2022
CCF Return Date
MRO ADDRESS
Texas MedClinic / Parmer
12319 North Mopac Expressway
Austin, TX 78758
(512) 835-5577 Fax (512) 836-0166
460595920
SSN
TEST PERFORMED :
Court-Order
DOT Test
X
TEST RESULTS :
(DOT tests comply with CFR Part 40)
Non-DOT Test
DRUGS :
Method :
Urine
Results :
Hair
X
X
Positive
Negative
Test Canceled
(See Remarks Below)
Test Not Performed
Remarks :
Test is Invalid
(See Remarks Below)
(See Remarks Below)
Reason(s) Test Not Performed and/or Test Canceled and/or Test ruled Invalid
(Specify)
Fatal Flaw : CCF / Other
Specimen Unsuitable: cannot obtain a valid result
Donor provided acceptable explanation
Donor provided unacceptable explanation
Specimen adulterated OR substituted: This constitutes a Refusal to Test
Specimen Dilute
Recommended Employer Action
A witnessed recollection:
Must
is recommended the next time the donor is selected for testing
take place immediately; contact the collection site ASAP
No further action is necessary unless a negative result is required (pre-employemnt, return-to-duty, follow-up)
An unwitnessed recollection is recommended.
Advise donor not to drink fluids prior to test.
ALCOHOL :
Method :
Urine
Results :
No alcohol present
Breath
Blood
Alcohol Present
Quantitation *
* This result represents raw laboratory data. We offer no opinion as to the degree of impairment this value represents.
It must be interpreted according to company policy and applicable state law.
COMMENTS :
MRO :
02/11/2022
James Bugg MD
MRO Name
MRO Signature
Date
Generated on 02/14/2022 9:34 AM
Laboratory Report
SPECIMEN INFORMATION
Requisition#: 6158457
Accession#: 612772X
DONOR INFORMATION
CLIENT INFORMATION
Name:
15077989
GAYLORD, LAUREN
Primary ID: 460595920
TEXAS MEDCLINIC HR HAIR
Collected:
02/08/2022
Reason:
OTHER
13722 EMBASSY ROW
Received:
02/09/2022
TX035
SAN ANTONIO, TX 78216
Reported:
02/11/2022
Collection
Site:
Specimen ID: 6158457
REPORT FOR:
TEXAS MEDCLINIC HR HAIR - 15077989
HR ACCOUNT
13722 EMBASSY ROW
SAN ANTONIO, TX 78216
EMPLOYER.
*** Negative Report ***
seals Intact; Yes
Tests ordered: 19870N (HAIR-5)
Hair specimen source
HAIR SOURCE
HEAD
Initial
Test Level
Hair substance Abuse Panel
AMPHETAMINES
AMPHETAMINE
METHAMPHETAMINE
MDA
MOMA
COCAINE/ METABOLITES
MARIJUANA METABOLITE
OPIATES
PHENCYCLIDINE (PCP)
Negative
Negative
Negative
Negative
Negative
Negative
Negative
Negative
300 pg/mg
300
1
500
300
pg/mg
pg/mg
pg/mg
pg/ mg
MS Confirm
Test Level
300
300
300
300
300
pg/mg
500 pg/mg
300 pg/mg
CERTIFYING TECHNICIAN/SCIENTIST: KSCN03
SPECIMEN RECEIVED AND PROCESSED IN THE LENEXA DHHS CERTIFIED LABORATORY.
Quest Diagnostics-Lenexa
10101 Renner Blvd
Lenexa KS 66219
>> END OF REPORT<<
pg/mg
.1 pg/mg
Hair Quantitative Results
LAB:
pg/mg
pg/mg
pg/mg