Urine Sample Chain of Custody
Donor Name
Date of Collection
Time of Collection
Donor ID/Number
Collector Name
Collector Signature
Specimen ID/Barcode
Test Type
Remarks
Chain of Custody Transfers
#
Date
Time
Released By (Name & Signature)
Received By (Name & Signature)
Purpose/Location/Remarks
1
2
3
4
Final Disposition:
Date:
Signature: