Provider Enrollment

Toxicology Services
Account Setup

Complete this form to establish your clinic's toxicology account with J. HUE Labs through Priority Toxicology Laboratories. Once submitted we will contact you within one business day to finalize your account.

Urine Drug Screening TDM Panels LC/MS/MS Confirmation Infectious Disease PCR Online Portal Access
Section 01
Submitter Information
Person completing this form
Section 02
Account Information
Your clinic or facility details
Section 03
Services Requested
Initial services your facility will require. This is not a standing order and is not binding.
Service Please Initial
Infectious Disease by PCR
Wound
UTI
Nail Fungus
COVID-19
Toxicology
Drug Screen by Immunoassay
Urine Validity by Immunoassay
Confirmation by LC/MS/MS

All patient samples will require an individual Requisition with patient name/DOB, tests/panels ordered, diagnosis codes, and insurance information. By initialing above you are indicating the type of testing your facility will require. This is in no way a standing order nor is it binding.

Section 04
Reporting Protocol & Specimen Transport
How you'd like to receive results and ship specimens
Section 05
Physician Acknowledgement & Consent
Required physician signatures authorizing the custom testing panel

As a part of my practice's compliance protocols, I hereby request and authorize Priority Toxicology Laboratories, LLC, to establish a customized testing panel for urine patient specimens from my practice for each of the prescription drugs and/or drug classes and illicit substance analytes selected by me.


I am authorizing Priority Toxicology Laboratories, LLC, to perform qualitative and quantitative testing for medications prescribed and illicit drugs when Point of Care Methods do not detect them and when I order such testing on the requisition. In my professional judgement the tests I ordered are medically necessary.


I acknowledge that I can modify my custom profile for individual patients based on medical necessity by identifying a new preference on the requisition.

Please provide the name of each ordering physician. Up to 5 physicians may be listed. Physical signatures will be required on the printed form which J. HUE Labs will send you to complete enrollment.

Section 06
Additional Notes
Anything else we should know about your practice or testing needs
Ready to Submit?

Once submitted, a J. HUE Labs representative will contact you within one business day to finalize your account and send the physical signature forms.

Questions? Call (501) 492-6797 or email Admin@jhuelabs.com

✓
Application Submitted!

Thank you for applying for a toxicology services account with J. HUE Labs. A member of our team will contact you within one business day to finalize your account setup and send your physical signature forms.

Questions in the meantime? Call (501) 492-6797