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The document is a U.S. Coast Guard Periodic Drug Testing Form, which outlines the requirements and procedures for drug testing under Title 46 CFR 16.220. It includes sections for applicant consent, laboratory information, and medical review officer details. The form specifies the types of substances tested, the responsibilities of the applicant regarding costs, and guidelines for submitting test results. Additionally, it provides instructions for periodic, random, and pre-employment testing options while ensuring compliance with federal regulations.

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