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Cedar Rapids Iowa online Form 8546: What You Should Know

All information provided must be accurate. The information received must match an identity that is on file with the medical center. The sample collected must be a non-toxic or toxic sample or one that matches the lab's standard. Sample testing is not required of urine samples collected. To determine if all the required information has been completed, the testing physician or laboratory employee must confirm with the clinic or clinic manager. Patient information labels or other forms must be placed on all requests to request tests. Patient information labels must be securely affixed to each request and kept in the same place as a patient's identification. Test Request Forms & Labeling — State Health and Nutrition Laboratory When a test request is approved and an exam is scheduled, request labels (and copies of labels) are sent to the test laboratory. Test Request Form— Iowa Department of Human Services All information is required by this form. The name of the patient is written on the Form and the name of the laboratory must be written on the top section. DTA DUTY FORM FOR AFFIRMATION OF A CERTIFICATION TO A PERSON RECEIVING A THERMOMETER SCREEN TO TEST FOR HERBAL CULTURE (THC) An affidavit of marijuana activity from a person receiving a THC screen must be submitted to the Iowa Medical Department with this request form. Certification Request for Testing or Permission to Use (LIVE STOCK) — Iowa Department of Community Health An affidavit form identifying the person as the primary caregiver of a child under the age of 19 and his or her legal name, date of birth, and social security number is required to request a test. The affidavit should be signed and notarized. The affidavit must be completed, dated, and signed by the caregiver and notarized by someone authorized to certify affidavits. A copy of the completed affidavit, signed and notarized by the authorized person, must be submitted to the state laboratory to be processed for confirmation. This form must be completed for each patient for whom an analysis will be requested. The results are provided to the patients by the county health department and are used to determine whether to provide the certificate to the patient. Iowa Patient Certificate for Certification to a Confederal Agent (U.S. Agent) A patient certificate that describes the results of the test and states that no additional evidence of noncompliance with the act is required to obtain certification to a U.S.

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