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8995EastMainStreet PostOfficeBox1430 Reynoldsburg,Ohio43068 www.odh.ohio.gov Ted Strickland, Governor Alvin. Jackson, M.D./DirectorofHealth Bureau of Alcohol and Drug Testing 614 / 6444609 614 / 7289179
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The fax completed form must be sent to the designated fax number.
The form must be filed by the designated individual or department specified by the organization.
The form should be filled out completely and accurately, following the instructions provided.
The purpose of the form is to document and submit important information.
The form may require information such as name, date, description, and any required attachments.
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