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From: Dr P
Password: orange
Date: 15 May 2008
Time: 06:26:49 -0700
Remote Name: 64.123.122.2
After dealing with too many inadequate responses from examining physicians I developed a form that I send them. I think others use something similar. The questions basically come right out of the regulations. Anyone else have ideas on this?
Please answer the following questions. Note that a typical urine drug screen requires only 45 ml of urine to be produced. Please also forward any supporting medical record as soon as possible.
1. In your professional opinion do you believe a medical condition has, or with a high degree of probability could have, precluded «DonorName» from providing a sufficient amount of urine on «DateofColl»? Please circle: YES or NO Please explain your rationale behind this determination:
2. Did «DonorName» offer any medical condition such as an ascertainable physiological condition (e.g., a urinary system dysfunction) or a medically documented pre-existing psychological disorder to explain his inability to produce a urine sample on «DateofColl»? Note: This does not include unsupported assertions of “situational anxiety” or dehydration. Please circle: YES or NO Please explain your answer: