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    Epassport #AI818323822Y

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    novikova.feo20
    Chto

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    © All Rights Reserved
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    Epassport #AI818323822Y

    Uploaded by

    novikova.feo20
    22 views1 page
    Chto

    Original Title

    ePassport #AI818323822Y

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    © © All Rights Reserved

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    Chto

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views1 page

    Epassport #AI818323822Y

    Uploaded by

    novikova.feo20
    Chto

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Scan this barcode into eScreen123®

    *AI818323822Y*
    AI818323822Y

    Instructions for VIACHESLAV NOVIKOV

    This order must be completed by: • You are required to take a photo ID,
    this ePassport, and all documents with
    which it printed.
    9/18/2023 5:14 PM (ET)
    • If you are under 18, a parent or legal
    Note: Completion time displayed does not mean that guardian may be required in order for
    the service provider is open until the time shown. services to be performed. Verify with
    the service provider before arriving.
    Please proceed to the following location:
    CityMD of Midwood
    1305 Kings Highway
    Brooklyn, NY 11229

    Phone: 718-280-5172 Fax: 718-280-5174


    Note: Please visit the service provider's website or call
    to confirm operational hours.

    Instructions for Service Provider


    Providers with eScreen123 must scan ePassport into eScreen123. Use eScreen Scheduled Event Account.
    Bill services to: eScreen, Inc., PO Box 25902, Regulation: NON-DOT
    Overland Park, KS 66225 Reason for Test: Pre-employment
    Services(1): 1. Urine Collection - 1200 - 5
    PANEL STANDARD (1200)
    Account: 107661-786
    MPEG Communications Corp
    Account Type: National Account

    Participant ID:

    © 2019 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective
    owners.

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