*AI18697028J4*AI18697028J4

ePassport™
Clinics with eScreen123 must scan passport into eScreen123. Complete all services.

Clinic Information:
C.C.O.M. - Pueblo
4112 OUTLOOK BLVD
STE 325
PUEBLO,CO 81008
ph #:719-760-4806
Fax: 719-630-1093
DON'T FORGET!
- Take ePassport and Photo ID
- All other documents provided
- Call clinic to confirm their hours of service

Scheduled Time: Between 2/14/2017 5:24:31 PM (MST) and 2/17/2017 5:00:00 PM (MST)

For Clinic Use: *Use eScreen Scheduled Event Account*

Scan the ePassport barcode into eScreen123.
Confirmation #: AI18697028J4 Scheduled Event Details will appear.
Regulation: NON-DOT
Reason for Test: Pre-employment Name: Barger Jacob

Services to be performed:
eCup
eScreen Acct #: 103407-1
USPS - CO/WY / Pre-employment

Account Type: National Account

Additional Requirements/Notes:
Please be prepared to provide sufficient urine for testing-allow up to 3 hours without leaving the premises. Clinic- Please note
any specimens that have to be sent to the laboratory must be shipped vi

Bill services to :
eScreen, Inc.
PO Box 25902
Overland Park, KS 66225

Contact eScreen Client Services with questions: (800) 881-0722 opt. 5