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Drugtestpablo

The document is a drug screen result form for donor Pablo Lawas Gian, conducted by Tomdeal Enterprises for pre-employment purposes. The results indicate negative tests for various drugs including cocaine, marijuana, opiates, and others. The specimen was collected and certified by Andro Dominic A. Calimot, M.D., ensuring it was not substituted or adulterated.

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brigolimeaflor
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513 views1 page

Drugtestpablo

The document is a drug screen result form for donor Pablo Lawas Gian, conducted by Tomdeal Enterprises for pre-employment purposes. The results indicate negative tests for various drugs including cocaine, marijuana, opiates, and others. The specimen was collected and certified by Andro Dominic A. Calimot, M.D., ensuring it was not substituted or adulterated.

Uploaded by

brigolimeaflor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Drug Screen Result Form

DONOR INFORMATION COMPANY INFORMATION


Donor Name : PABLO LAWAS GIAN___ Company/Referring Agency: Tomdeal
Enterprises
SSN: _____NONE_______ DOB:__JUNE 29, 1976__ Address: Tamiao Compostela,Cebu_
Phone: 09859978536_

Email: pablolgian@gmail.com City:__Cebu City__ State: __PH_____ Zip:_6000___


Reason for Test: Pre-employment ✓ Random Phone: (032) 418-1800
F Post Accident Other________________________ Email: Tomdeal Enterprises@gmail.com

TO BE COMPLETED BY DONOR:
I certify that the specimen provided is my own and has not been substituted or adulterated. I further agree and grant
permission for the testing of my urine specimen for drug metabolites and or alcohol. I voluntarily consent to this
testing.

PABLO LAWAS GIAN ____________________________________________ ___03/03/2025________


Print Donor Name Donor’s Signature Date / Time

TO BE COMPLETED BY SCREENING PERSONNEL


Drug Name Device Code Cut-Off-Level Negative Positive Not Tested
Cocaine COC 300ng/ml F G G
Marijuana THC 50ng/ml F G G
Opiates OPI 2000ng/ml F G G
Meth-Amphetamine METH 1000ng/ml F G G
Amphetamine AMP 1000ng/ml
F G G
Methadone MTD 300ng/ml
10ng/ml F G G
Burprenorphine BUP
Benzodiazepines BZO 300ng/ml F G G
MDMA 500ng/ml F G G
OXY 100ng/ml F G G
MDMA
ETG 500ng/ml
Oxycodone F G G
Alcohol F G G

Specimen Temperature (90-100 F.) F Yes G No


I certify that l collected the specimen provided by the aforementioned Donor and that it was not
substituted or adulterated to the best of my knowledge. The specimen temperature and color were
acceptable I have verified the donor identity by review of the donor’s picture lD or by employer or test
request or verification.

ANDRO DOMINIC A. CALIMOT, M.D.


Lic. No. 0159478_______________________ ____________________________________________ 03/03/2025
Print Collector Name Collector’s Signature Date / Time

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