Urine Drug Screen Form Template

Must Ask Urine Drug Screen Questions

1. What is the reason for testing (pre-employment, random, post-accident, return-to-duty, or follow-up)?

   This sets policy and regulatory context, which affects timing, documentation, and review. It also guides which panel and cutoff levels you should use.

2. What is your full legal name, date of birth, and government ID type/number for verification?

   Accurate identification protects chain of custody and prevents mismatched records. It reduces reporting errors and speeds employer or provider decisions.

3. Which test panel is required (5-, 10-, or 12-panel) and should non-negative results be confirmed by a certified lab?

   Defining scope avoids under- or over-testing and sets turnaround expectations. Allowing automatic confirmation reduces disputes and supports defensible results.

4. What prescription medications, over-the-counter drugs, and supplements have you taken in the past 72 hours?

   This context helps a medical review officer evaluate potential legitimate positives. It improves accuracy while avoiding unnecessary retests.

5. Who is authorized to receive the results, and do you consent to that release and to testing?

   Clear authorization supports privacy compliance and ensures the right person is notified. If follow-up care is needed, you can include a Discharge instructions form to share next steps.