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Offender Name
Type of Case
Drugs/Alcohol
Larceny, Forgery, Etc.
Anger Management
Testing Times
Single Test
Random Testing (Weekly)
Random Testing (Monthly)
How many Tests
(per week/month)
How long
Type of Test
Oral Fluid Drug Test - $25
EtG Urine Test - $35
EtG/8 Panel Urine Test Combo - $40
Hair Follicle Drug Test - $75
Specific Instructions
Requested By
Date
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form script
we used for this form.