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335 N. 120th Avenue
M-F 7AM – 6PM
(616) 392-5222
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Home
Services
Workplace Injury Care and Management
Physicals
Physical Demand Testing
Drug and Alcohol Testing
Audiograms, Respirator & Specialty Testing
Baseline, Annual & Exit Testing
Medical Surveillance
Regulatory Compliance
OnSite Services
Company Site Visits
Supervisor Programs
OnSite
Program Overview
Service Listing
About
Forms
Reporting
& Records
Contact Us
Contact Us
Authorize to Treat Form
Printable Authorize to Treat Form
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Authorized By Name
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Authorizer Phone
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Employee Information
Employee Name
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Last
Employee Date of Birth
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INJURY
Treatment/Evaluation
Treatment Options
Drug Screen with initial visit
Breath Alcohol Test
DOT Procedures
Physical Examination
Select One
New
Recertification
Follow-up
Drug Test - Federally Mandated
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Urine
Reason For Drug Test
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Pre-employment
Random
Reasonable Suspicion/Cause
Post Accident
Return to Work
Follow-up
DOT - Specify DOT Agency
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FMCSA
FTA
FAA
PHMSA
FRA
USCG
Alcohol Test - Federally Mandated
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Breath Alcohol Test
Reason For Alcohol Test
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Pre-employment
Random
Reasonable Suspicion/Cause
Post Accident
Return to Work
Follow-up
Non-DOT Procedures
Physical Examination
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Post Offer/Pre-employment
Return to Work
Fit for Duty
Respiratory
Hazmat
Asbestos
Other
Drug Test - Type
Pre-established Protocol (HMC Clients)
Test @ HMC-rapid screen
Collection ONLY-Urine
Hair Collection
Saliva
Direct Observe
Drug Test Protocol
(Required)
Select One
6
10
Nicotine
Reason For Drug Test
Select One
Pre-employment
Random
Reasonable Suspicion/Cause
Post Accident
Return to Work
Follow-up
Alcohol Test - Type
Select One
Breath Alcohol Test
Reason For Alcohol Test
Select One
Pre-employment
Random
Reasonable Suspicion/Cause
Post Accident
Return to Work
Follow-up
Other
Other test options
Chest X-Ray
Pulmonary Function Test
Audiogram baseline
Vision Titmus
Respirator Fit Test
Tetanus
Audio Annual
Vision Ishahara
Audio Follow-up
Vision Jaeger
Labs
Hepatitis B Vaccine
Tuberculosis (TB)
Titer
Lift test & education
Lab details
(Required)
Hepatitis B Vaccine Number
(Required)
TB Testing Options
(Required)
1 Step
2 Step
Titer Type
(Required)
Lift Test & Education Number
(Required)
Other Instructions
Company instructions: Other testing and/or company specific instructions
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