Service Provider Account

*AI***********

AI**********

Instructions for Service Provider

Please proceed to the following location:

Concentra Medical Center - Westside

**** ******** ******* *******

JACKSONVILLE, FL 32221

904-***-****

Providers with eScreen123 must scan ePassport into eScreen123. Use eScreen Scheduled Event Account. Scan this barcode into eScreen123®

Instructions for Cortney Harris

Participant ID:

Account: 132***-****

BlueCrew

This order must be completed by:

8/19/2022 10:59 PM (ET)

Account Type: National Account

Phone:

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

Note: Completion time displayed does not mean that the service provider is open until the time shown. Note: Please visit the service provider's website or call to confirm operational hours.

Additional Notes: During the COVID 19 pandemic, we recommend wearing masks when visiting a clinic for services. If you have questions regarding measures being taken at the facility, please call the clinic. Bill services to: eScreen, Inc., PO Box 25902,

Overland Park, KS 66225

• You are required to take a photo ID,

this ePassport, and all documents with

which it printed.

• If you are under 18, a parent or legal

guardian may be required in order for

services to be performed. Verify with

the service provider before arriving.

Fax: 904-***-****

Services(1):

Regulation: NON-DOT

Reason for Test: Pre-employment

1. eCup

Contact this candidate