Drug Test Results Form
61246-3-FUO - DrugCheck NxStep OnSite Drug Test
Client Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Temperature
*
Lot Number:
*
POSITIVE
NEGATIVE
N/A
AMP
BUP
BZO
COC
FEN
mAMP
MOP
MDMA
MET
MTD
OPI
OXY
THC
ETG
CR
NI
GL
Kratom
Breath
Alcohol
Tianeptine
Add Image if Results are Positive
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House Manager Name
*
First Name
Last Name
House Manager Sign
*
Witness Name
*
First Name
Last Name
Witness Sign
*
Client Sign
*
Submit
Should be Empty: