TITLE:Chain of Custody Form Handling and Authority

TASC Laboratories

GUIDELINE

TITLE:Chain of Custody Form Handling and Authority

AUTHORITY TO ORDER TESTS:

An authorized person or Agency, which is an individual authorized under State law to order tests and or receive test results.
TASC case workers responsible for individual clients
TASC support staff may order upon direction of the case worker
Non-TASC agencies being provided services under contract with TASC Labs.

Agencies conducting drug testing should acknowledge the legal mandates for authorization from:
Ordered by the court or parole board
State statue
Written Administrative policies of a specific agency.

Private Referrals, such as Attorney Offices, Parents or Guardians, or Individuals themselves, such as cases of expungement.

Attorney Offices or Parents, must provide a written request naming the specimen donor.
Individuals presenting themselves are not required to have written requests.
Photo ID is required for all individuals.
Copy of the Custody Form is retained by donor in this group.

PRINCIPLE:

The URINE DRUG SCREEN CUSTODY FORM is the document which provides the client identification and instructs the laboratory of what tests to perform, where the results should be sent and who should be billed for the laboratory services. It isvery important that the requisition form is completed correctly and completely. Failure to follow the instructions may delay test results or even prohibit actual testing.

This procedure is a detailed description for completing the Custody Form. It is intended as a training reference. Please refer to the following documents for additional information:

The Specimen Collection provides a description of the types of collections.

The Chain of Custody provides an overview of the entire collection process.

There are five (5) sections of the Custody Form that must be completed: Referred by, Completed by the Donor, Completed by Collector, Completed by Laboratory and Specimen Bottle Seal. (The Bottle Seal is located on the BOTTOM of the form.) Proper completion of all the sections creates the Chain of Custody for the specimen.

I. "Referred by" Section: (The TOP area of the form usually completed by the Collector)

The Name of the Program / Agency / Location (and address when necessary) where the results are to be sent must be printed legibly in the Upper Left Hand Corner. Some agencies have more than one location, so please be specific. (eg: TASC-Roosevelt and Roosevelt-RCP) Incorrect information will obviously cause test results to be sent to the wrong location. The laboratory cannot accept the specimen without this information.

IF results are to be sent to another Agency (eg: DCFS-LSSI, etc.), specify the Agency Name and Fax Number.
This section is ALSO used for Billing purposes:
IF testing covered by a TASC Program (eg: ACJS, JJS, DCFS-RCP, etc.), use the customary abbreviation of the Program.
IF testing is covered by another agency’s program (eg: DCFS – LSSI), please clearly indicate the account.
IF the Agency is to be billed, please write “Bill Agency” in this section and include the billing address and BOTH the phone and fax numbers.

The Collection Site and Contact Person may also be recorded in advance. The Collection Site should be completed if it isnotthe same as the Agency location. The Contact Person is typically the Agency's case-manager or individual responsible for this client, or the coordinator of the Program. This person's name will appear on the report and is helpful in routing results to the proper individuals. It may be different from the name of the person who is the Collector.

NOTE: In the event an Agency sends a client into a TASC Office for specimen collection, a Referral Notice from the agency is required. This notice may be the Agency's own referral card, letterhead, TASCLabs Referral Form, or some similar document, which identifies the agency and its address. Please attach a copy of any Referral Notice to the original copy of the requisition.

The following information must also appear on the Referral Document.

Client Name
Agency Contact Person / Case Manager
Test(s) Requested
Write "Self-Pay" if the client is paying for the testing, otherwise the Agency will be billed. "Self-Pay" clients must pay before receiving services. Forward payments to the Area Administrator or to the Accounts Receivable Department at the corporate office in Chicago.

II. "Completed by the Donor" Section:

In order for the test results to be admissible in court, this section must be completed accurately and completely. Failure to complete just one item in this area can violate the chain of custody and cause the test results to not be admissible.

The client or the Collector may complete this section. If the client completes this section, the Collector must make sure the information is printed and legible. Please use a ballpoint pen and press hard to imprint all the copies of the form.

NOTE: It is acceptable to partially complete the form in advance of the client contact. However, the areas specific to the individual client should always be verified at the time of specimen collection. (Client ID, Name, Self-Reported Usage, etc.)

There MUST be a Client ID. This number is typically the client's social security number SSN.
The Client ID must be unique and match the ID used in the CTS/ECR system. IF the number does not match, test results will not appear in the CTS/ECR system.
NEVER use the client’s birth date as the ID! It is not a unique number.
Do NOT rely upon the DCFS number because all members of the family use the same base number.
The TASC Client Tracking and Electronic Chart System will allow the creation of a temporary ID. Contact Management Information Services (MIS) for additional information.
The State ID or Driver’s License Number may be an acceptable alternate on a temporary basis, until the SSN is known and verified.

4.2.A photo ID (driver's license) is generally accepted as a positive identification.

4.3.In the event a Client ID is not provided or assigned, the Laboratory will use the Reference Number (Specimen ID), of the Custody Form, as the temporary ID. The Collector will need to notify the laboratory when a valid Client ID is obtained.

Complete the remainder of the client identification (Name, DOB & Sex)

Ask the client if there is any "Self Reported Usage" or “Medications” to report. Make an appropriate notation in the section.
Inquire about possible prescriptions from their doctor or over-the-counter medicines currently being used. You may ask to see the prescription bottles as proof, especially when repeating any positive results. If you do, look at the bottles and check the name and date the prescription was filled. This information should be current and belonging to the client.
Record medications in the space provided. If list is extensive and already noted in the client’s record, it is acceptable to simply write “Meds on Record” or similar wording.

The client must sign by the X and DATE this section of the form to certify the specimen was not adulterated, that it is their sample and to permit testing.

NOTE: Juveniles over the age of 12 years old must sign the Custody Form, even when the parent or legal guardian is requesting the testing.

Please have the client then Date and Initial the lines provided on the "Specimen Bottle Seal" label, located on the BOTTOM of the form.
Keep the Seal Strip ON the Custody Form until you are ready to seal the closed specimen container in the presence of the client. This is to prevent any mix up of labels and requisitions. Clients are NOT to seal the specimen as you must check the temperature and insure the container is closed before applying the seal.

III. "Completed by Collector" Section:

The COLLECTOR (person overseeing the collection) MUST complete the required information to certify the specimen.

REMINDER: Proper chain of custody requires an identification of the SITE where the specimen was collected, if it is different from the Agency's location. This information is noted at the TOP-RIGHT of the Custody Form.

On the colored bar at the start of the section are three boxes marked as ( ) Supervised, ( ) Monitored and ( ) Observed to indicate the Type of Collection. A Supervised collection is where the collector is simply outside the washroom door. Monitored indicates the collector is IN the washroom and just outside the stall being used, and Observed indicates direct observation of the drop by the collector. Please mark the appropriate box, especially if the collection is "Observed". This information does not appear on the laboratory report.

The temperature question is optional, unless the collection container has a temperature strip. Without the strip, the collector may answer the question if the sample is warm to the touch, otherwise simply leave it blank. This information does not appear on the laboratory report.

HINT: If the sample is cold or appears clear as water, you can request the client to provide another sample.

Mark the box next as to the test(s) to be performed on the specimen. The individual Program / Agency may have specific tests required. Otherwise, you can choose any test listed in any combination. It is permissible to "pre-select" and mark what tests are requested prior to the actual drop. The laboratory will test only those tests that are marked off on the test request form. If a specimen is received with no test(s) indicated, the laboratory will perform the NIDA-5 panel as a default.

NOTE: The NIDA-5 consists of PCP, Opiates, Amphetamines, Marijuana and Cocaine.

The Collector then signs by the X and Date in the space provided, to indicate the collection is completed and the information is correct. Collection Time may be recorded, especially if a “court ordered” drop.

The Collector Remarks area may be used for comments. An example a Collector's comment: "client drank three glasses of water before the drop".

IV. "Completed by Laboratory" Section:

The Laboratory staff will Initial and Date the form to reflect when the sample was received and opened. This completes the Chain of Custody for the sample. Upon opening the incoming packages, the Laboratory checks each sample for "Fatal Flaws" as indicated on the requisition form. The presence of certain key flaws will result in notification to the agency and possible cancellation of the drug tests.

V. Tamper Seal: (WHITE Peal-Off Strip at the BOTTOM edge of form)

SAFETY NOTE: Wear disposable gloves when handling specimens.

The client should have dated and initialed the Tamper Seal at the time of signing the CustodyForm. If not, have them do so before labeling the sample.

Upon receiving the specimen from the client, please make sure the specimen container is tightly closed, by personally giving the cover an extra twist. One of the more frequent "Fatal Flaws" is the leaking of samples. Be sure the top is secure and tight before sealing.

Verify the Custody Form with the client to insure you have the correct document. This is required if multiple clients are being collected with supervised and not observed.

Peal the White "Specimen Bottle Seal" strip from the bottom of the test request form and wrap the strip over the bottle. Center the label's "dot" on the top of the container so that the specimen number is on the side.

The PINK copy of the form may be issued to the client for their records. The yellow copy may be retained for your Agency's records. The original signed copy is always sent with the specimen to TASC Labs.

Package and send the specimen to the laboratory in accordance with proper transportation requirements. (See Specimen Transport)