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Scan this barcode into eScreen123® Instructions for Sheila Philbert This order must be completed by: 9/22/2019 4:13 PM (ET) Please proceed to the following location: Paramount Urg Care Inc - Orlando 8972 Turkey Lake Rd Ste A300 Orlando, FL 32819 Phone: 407-226-1906 Providers with eScreen123 must scan ePassport into eScreen123. Use eScreen Scheduled Event Account. Account: 102732-3 AMN American Mobile Account Type: National Account Participant ID: PID: 5962292 Note: Completion time displayed does not mean that the service provider is open until the time shown. Note: Please call service provider for operational hours and to schedule an appointment or visit the service provider's website for hours of operation. Bill services to: eScreen, Inc., PO Box 25902, Overland Park, KS 66225 © 2019 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. *AI309070718X* AI309070718X • 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: 407-226-1910 Instructions for Service Provider Regulation: NON-DOT Reason for Test: Pre-employment Services(1): Reason for Service: Pre-employment Services(3): 1. Urine Collection - 3125 - XC-10 PANEL (3125) 1. Vision Test, Ishihara 2. 3. Vision AMN NonDOT Test, Snellen Physical and Clearance Form AI309070718X Confirmation 102732-3 eScreen Account #: 43944 Clinic #: AI309070718X Applicant/Employee Name: Philbert, Sheila Confirmation Number: AI309070718X eScreen Account Info: 102732-3