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Attaclunent E <br />B—CRCAPPLICANT/CARDHOLDERDRUGTESL' <br />INFORMATIONAND INSTRUCTION SHEET <br />BCRC is exercising extreme care to ensure that strict quality control measures are <br />followed in the collection, handling, and analysis of your specimen. You play an <br />important role in this process and should be certain that you have prodded an <br />unadulterated specimen to the laboratory. Remember, you arc certifying that the <br />specimen which you provide is yours and is unadulterated. Any adulteration or <br />switching ofspccimcn is a breach of BCRCs rules and, ifyou arc employed, may <br />subject you to discipline up to and including termination by your Employee <br />For your awn protection and peace of mind, we ask that you: <br />ProAde a picture identification to the collection site/technician at time <br />ofarrival; <br />Be escorted to a coRcction room and asked to provide an unadulterated <br />specimen in the collection bottle provided. The bottle should be filled <br />to 45 4- <br />Return the specimen bottle to the medical technician and witness, <br />initial and date the integrity seals placed on your specimen; <br />Verify the proper spelling ofyour name as recorded on the log sheet; <br />• Verify that your social security number has been properly recorded <br />Verify that the social security number placed on your specimen bottle <br />is the same as that recorded on the log shot and the Custody and <br />Control Form. <br />IIIAVE READTIIEABOVEAND IIAVETUD AN OPPORTUNITY <br />TO ASK QUESTIONS REGARDINGTHIS PROCEDURE. <br />BCRCApplieant/Cvdho1&rSigruture Due <br />