This page was last updated: July 30, 2006

Ethylglucuronide     

a test to monitor  and encourage abstinence...

EtG

Participant Registry

1. Your name:

5. Reason EtG test ordered?     (If known)

Please explain:

9. Possible "incidental" exposure to alcohol?

                                                      Explain:

7. Urine alcohol also positive?

11. Lab who performed EtG test?

Click to submit data!

Other reason and/or explain:

10. Alcohol use history?

Please explain:

6. EtG assay positive?

8. Creatinine value on urine sample? (if known)

Registry - for individuals who believe they've been falsely accused of drinking because of one or more EtG tests

2. Email Address:

3. Your Profession:

4. Sex

5. Age:

Amount:

Explain all positives (amt, date, as much as known bleow:

Date:

Level (amount):

12. This is follow-up information from a previous report.

13. Name of the agency that is monitoring me:

MaleFemale

For Cause (suspicion of drinking)
Confirmation of positive urine alcohol
Routine random testing

YesNo

YesNo

Alcohol Abuse
Alcoholism
Drug problem
Unknown

YesNo