Drug Screen Registration Instructions 21513057848210
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Fidelity Information Services, Inc. (10 yr) Drug Screen Registration Instructions Full name: Request number: Jackson Samuel Daniel Sudharson HA-120117-J54U9 Dear Jackson Samuel Daniel Sudharson: HireRight is a third-party administrator that has been contracted by Fidelity Information Services, Inc. (10 yr) to arrange all the details of your drug screening. Please follow the instructions below to complete your screening. Your authorization number is 22923840. This registration expires on December 11, 2017 02:59 PM CST. The following specimen collection site has been selected for your drug screen: Quest Diagnostics-Layton PSC 4852 S 6th St, Milwaukee, WI 53221 (414) 483-4660 Show on map Please take this page with you to the specimen collection site. When you arrive at the collection site, please present this page and a government-issued photo ID. We recommend that you call the collection site in advance for hours of operation and availability. The expiration date/time of your registration may not align with the hours of operation for the collection site. Also, some collection sites may require arrival one hour before closing time. Please note that children will not be allowed into the testing area with you. If you have small children who will be accompanying you to the testing facility, they will be required to remain in the waiting room during your visit. Please arrange to have another adult with you to supervise any infants or children that accompany you to the facility. If you would prefer an alternate location, you may also locate a Quest specimen collection site by completing the following steps: 1. Go to http://www.questdiagnostics.com/hcp/psc/jsp/hcp_psc_index.jsp. 2. In Section 1, enter your preferred street address or ZIP code. 3. In Section 2, make the following selections: - Drug Testing - Urine Drug Test 4. Click "Find". 5. If available, please select only facilities named Quest Diagnostics. 6. No additional registration steps are required; simply take this authorization form to the new collection site prior to the expiration date and time. COLLECTOR INSTRUCTIONS: QUEST APPROVED AUTHORIZATION FORM Forensic Drug Testing Authorization Form Order Expiration Date/Time: December 11, 2017 02:59 PM CST. Authorization Barcode #: 22923840 Employer Information Fidelity Information Services, Inc. (10 yr) customerservice@hireright.com Medical Review Officer/Managed Service Provider NDI, A HIRERIGHT COMPANY 4600 PARK ROAD, SUITE 500 CHARLOTTE, NC 28209 Phone#: (800)272-3350 Fax#: (704)364-5961 Test Information Donor Information Name: Jackson Samuel Daniel Sudharson ID: ***-**-9487 Test Details Reason for Test: Pre-employment Account: 10273092 Service(s) to be Performed Service Urine Drug Test Laboratory Laboratory Test Quest Diagnostics 9 Panel as established for customer's account Please contact HireRight Drug and Health Screening Customer Service by phone at (866) 521-6995, option 1 or by email at OHSCustomerService@hireright.com if you have further questions regarding the process. Customer Service Drug and Health Screening HireRight, Inc. Phone: (866) 521-6995, option 1
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