Quest Diagnostics Investments, Inc.

R H Barry Sample

Eric J Quilter

A chain-of-custody form has integrated removable specimen seals, and the form may be used to identify a test sample collected from a donor and to document the handling of the test sample. The form may be printed upon a single sheet that has a first portion and a second portion. The first portion includes a first section having one or more spaces for recording demographic and testing information, and one or more indicia of the information to be recorded in one or more marked spaces; and a second section having a marked space for the donor to affix a signature and one or more indicia of the purpose of the space. An identifier that is unique to the form is recorded within the first portion and within the second portion. The identifier includes an specimen identification number or some other method of specimen identification such as a bar-code.

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Seneca, SC, United States of America

R H Barry Sample