Drug Test Supply Order Form

Complete the following form to order drug testing supplies with your LabCorp account number.

Contact Information

Your Name

Phone

Address

City

State

ZIP Code

Company Name

LabCorp Account Number

Location Code (if applicable)

Supplies Requested

Please indicate whether you are the LabCorp customer or a collection facility ordering supplies on behalf of the customer.

LabCorp Customer

Collection Site

Enter quantity requested for each item ordered. Specimen Collection Kits (minimum 10 kits – max. 200, increments, of 25)

Standard Two – (2) Vial Collection Kit - 200GV

Kit includes: 1 - Biohazard Specimen Shipping Bag 1- Wide Mouth Collection Cup with Temperature Strip 2 - 45ml UrineSpecimen Transport Vial

Courier Kit – KT-Cour

Kit includes: 1 - Biohazard Specimen Shipping Bag 1 - 90ml Urine Specimen Container with Temperature Strip

Courier Kit Special Requirements or Comments

Chain of Custody Forms

(min.10 forms, increments of 25, max 500)

(A) Standard Five – (5) Part Non-Federal COC - 590-5P BC/590 5B BC

(B )Federal Form - 575 DOT

(D) Federal Look-a-Like - 580

Web Chain of Custody (COC) Form Paper with tamper-evident specimen seals (1000 page increments)

(A) Web COC Paper (one case accommodates 1000 specimen collections)

(min.10 forms, increments of 25, max 500)

Miscellaneus Supplies

Biohazard Bag with Zipper

White Printer Paper

Employer Information

Required for all chain of custody orders (A-D)

Copy from Contact Information

Employer

Street Address

City

State

ZIP Code

Telephone number

Medical Review Officer Information

Required for all chain of custody orders (A-D)

Copy from Contact Information

Employer

Street Address

City

State

ZIP Code

Telephone Number

Shipping Information

Required for all chain of custody orders (A-D)

Copy from Contact Information

Employer

Street Address

City

State

ZIP Code

Telephone Number

Overnight Shipping Request

All supplies shipped via ground unless customer’s overnight courier account information is provided.
Allow 3-10 business days for ground delivery.

Courier Name

Courier Account Number

Courier Name (if Other)

Special Shipping Instructions

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