I, [Consenter], understand that [Requester] requires my authorization to conduct a drug test [in order to][in connection with] _________________________________________________________________________________________________________________________________________. I have been informed of and understand the testing procedure.
I agree to provide any specimens needed to conduct the drug test. I understand that if I refuse to undergo drug screening, ____________________________________________. I further understand that if I consent to the test and the results are positive, the results will be reported to [Requester] and I may be _______________________________________ for violation of [Requester’s] drug policy. This policy exempts the use of legally prescribed medications taken under the direction of a physician. (Optional) [I have taken the following drugs or substances within the last 96 hours:….
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