LABORATORY REPORT CLIA ID#: 23D2036829 Phone: 517-575-6487 Fax: 517-575-6492 2025 S. Washington Ave Suite 202, Lansing, MI 48910 Laboratory Director: Michael Barna, M.D. Patient’s Name DOB JOHN TEST 12/30/1987 Gender Patient Id(MR#) Accession Number Male 12345 10 Collected 08/07/2013 Physician Client Address Received Reported FEDELI, RICHARD PSO 2025 S. WASHINGTON AVE LANSING, MI 48910 08/07/2013 08/08/2013 Prescribed Medication(s) CARISOPRODOL, OXYCODONE, CLINIC SCREEN RESULTS Drug AMP POS NEG NOT Drug X COC X X BAR BZO POS NEG NOT Drug X MTD X X MDMA THC POS NEG NOT Drug X OXY X X MAMP OPI PCP PPX POS NEG NOT Drug X BUP X X TCA Summary Report Expected/Positive Analyte OXYCODONE Results POSITIVE Level(ng/mL) > 1000.0 NG/ML Cuttoffs 4.8 Unexpected/Absent Analyte CARISOPRODOL Results NEG Level(ng/mL) 0 NG/ML Cuttoffs 4.29 Unexpected/Positive Analyte 1-(3-C)PIPERAZIN DIAZEPAM NOROXYCODONE Results POSITIVE POSITIVE POSITIVE Level(ng/mL) > 100.0 NG/ML 4.5 NG/ML 75.2 NG/ML Cuttoffs 2.1 1.5 5.8 Test Screen AMPHETAMINE AMPHETAMINE TFMPP BENZYLPIPERAZINE MDA MDEA MDMA MEPHEDRONE METHAMPHETAMINE PHENTERMINE 1-(3-C)PIPERAZIN Results Cutoff Conc NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED POS/Inconsistent 2.1 NG/ML 2.7 NG/ML 5.5 NG/ML 3.6 NG/ML 3.3 NG/ML 3.8 NG/ML 1.5 NG/ML 3.5 NG/ML 4.6 NG/ML 2.1 NG/ML > 100.0 NG/ML NOT DETECTED 4.6 NG/ML NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED 20.3 NG/ML 8.8 NG/ML 20.9 NG/ML 10.2 NG/ML 22.5 NG/ML NOT DETECTED 2.9 NG/ML NOT DETECTED NOT DETECTED POS/Inconsistent NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED 3.8 NG/ML 1.1 NG/ML 1.5 NG/ML 2.2 NG/ML 2.9 NG/ML 4.7 NG/ML 2.9 NG/ML 2.7 NG/ML 2.0 NG/ML 3.3 NG/ML NOT DETECTED 1.5 NG/ML NOT DETECTED NOT DETECTED 3.1 NG/ML 4.9 NG/ML NOT DETECTED NOT DETECTED 1.7 NG/ML 4.0 NG/ML NOT DETECTED 2.6 NG/ML PREGABLIN PREGABLIN BARBITURATES BUTABARBITAL BUTALBITAL PENTOBARBITAL PHENOBARBITAL SECOBARBITAL ANXIOLYTIC MEPROBAMATE BENZODIAZEPINES 7-AMINOCLONAZEPA ALPRAZOLAM DIAZEPAM FLUNITRAZEPAM FLURAZEPAM LORAZEPAM NORDIAZEPAM OXAZEPAM TEMAZEPAM A-OH-ALPRAZOLAM BMP ACETAMINOPHEN COCAINE BENZOYLECGONINE COCAINE DISSOCATIVE KETAMINE PHENCYCLIDINE GABAPENTIN GABAPENTIN 4.5 NG/ML Comments POS NEG NOT X X LABORATORY REPORT CLIA ID#: 23D2036829 Phone: 517-575-6487 Fax: 517-575-6492 2025 S. Washington Ave Suite 202, Lansing, MI 48910 Laboratory Director: Michael Barna, M.D. Patient’s Name DOB JOHN TEST 12/30/1987 Gender Patient Id(MR#) Accession Number Male 12345 10 Collected 08/07/2013 Physician Client Address Received Reported FEDELI, RICHARD PSO 2025 S. WASHINGTON AVE LANSING, MI 48910 08/07/2013 08/08/2013 Test Screen METHYLPHENIDATE METHYLPHENIDATE RITALINIC ACID Results Cutoff Conc NOT DETECTED NOT DETECTED 1.3 NG/ML 2.74 NG/ML NEG/Inconsistent NOT DETECTED 4.29 NG/ML 7.0 NG/ML NOT DETECTED NOT DETECTED 39.5 NG/ML 1.7 NG/ML NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED 2.8 NG/ML 10.5 NG/ML 4.8 NG/ML 4.0 NG/ML 4.0 NG/ML 1.9 NG/ML 13.0 NG/ML 5.0 NG/ML 12.6 NG/ML NOT DETECTED NOT DETECTED 4.9 NG/ML 11.2 NG/ML NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED POS/Inconsistent NOT DETECTED DETECTED NOT DETECTED NOT DETECTED NOT DETECTED 6.4 NG/ML 10.2 NG/ML 7.8 NG/ML 9.1 NG/ML 4.1 NG/ML 3.1 NG/ML 5.8 NG/ML 75.2 NG/ML 12.8 NG/ML 4.8 NG/ML> 1000.0 NG/ML 8.1 NG/ML 2.3 NG/ML 5.0 NG/ML MUSCLE RELAXANT CARISOPRODOL CYCLOBENZAPRINE NSAID IBUPROFEN NAPROXEN OPIATES & SSO 6-MAM CODEINE DI-HYDROCODEINE HYDROCODONE HYDROMORPHONE MEPERIDINE MORPHINE NORHYDROCODONE OXYMORPHONE ANTIDEPRESSANTS CITALOPRAM FLUOXETINE SYNTH OPIATES BUPRENORPHINE EDDP FENTANYL METHADONE NORBUPRENORPHINE NORFENTANYL NOROXYCODONE NORPROPOXYPHENE OXYCODONE PROPOXYPHENE TAPENTADOL TRAMADOL THC NORCARBOXY-D9 NOT DETECTED 8.7 NG/ML NOT DETECTED NOT DETECTED NOT DETECTED NOT DETECTED 7.5 NG/ML 7.7 NG/ML 11.4 NG/ML 5.5 NG/ML TRICYCLICS AMITRIPYLINE DOXEPIN DULOXETINE NORDOXEPIN Comments
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