P rovidence Associates Medical Laboratories (PAML) Employee Drug Screen Authorization
Company: Eastern WA U Phys Thrpy/HFHED PAML Client Account #: 9833-6
Donor: ___________________________________ SS#/ID#: _______________________
Authorized Signature: __________________________
Date: ______________ Time: ____________ AM/PM
Please Indicate:
Reason for Test: Type of Test: Protocol:
Pre-Employment ■Urine Drug DOT mandated
Random UA and Breath Alcohol ■ EDS50
Post-Accident Breath Alcohol Other: ____________
Return to Duty Other: _______
For Cause
Other: _COLLECT $15.00 AT TIME OF COLLECTION ____________________
Questions please call PAML Toxicology 509-755-8991
Northpointe Service Center / Spokane
9631 North Nevada #109
Spokane, WA 99218
(509) 921-7050 Fax 509-755-8432
hours of collection: 9am-4pm,
North Spokane Service Center
5901 North Lidgerwood #124
Spokane, WA 99207
(509) 755-8834 Fax 509-482-7906
hours of collection: 9am-4pm
Medicus Building/ Spokane Valley
12615 East Mission #100
Spokane, WA 99216
(509) 927-6286 Fax 509-755-8438
hours of collection: 9am-4pm Breath Alcohol
PAML at Franklin Park Medical
220 E Rowan Ste 250
Spokane, WA 99207
(509 744-8139 Fax 509-232-4293
5 th and Browne/Downtown Spokane
104 W Fifth #125 East Wing
Spokane WA 99216
(509) 921-7066 Fax 509-455-9938
hours of collection: 9am-4pm
(Not collecting Drug Screens due to remodel
Will be closed til Dec 1 st )
Alpha Medical Lab/Coeur d’ Alene
700 Ironwood Dr #108
Coeur d; Alene ID 83814
(208) 664-8249 Fax 208-765-8615
hours of collection: 9am-4pm
Alpha Medical Lab/Post Falls
1300 E Mullan
Post Falls ID 83854
(208) 777-1344 Fax 208-777-1313
hours of collection: 9am-4pm
Questions please call PAML Toxicology 509-755-8991
hours 9am-4pm (Breathe Alcohol)
Questions please call PAML Toxicology 509-755-8991