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Patients Doctor
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Pregnant?
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Random or Scheduled
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UDS Observed?
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Used illicit substances?
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If other illicit substance, please list:
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BUPRENORPHINE(BUP)
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BENZODIAZIPINES (BZO)
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BARBITURATES(BAR)
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OXYCODONE(OXY)
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OPIATES (OPI)
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METHADONE(MTD)
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MARIJUANA (THC)
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METH-AMPHETAMINE(M-AMP)
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AMPHETAMINE(AMP)
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COCAINE(COC)
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UDS Panel(s) Ordered for Confirmation
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Comments
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