BLOOD/SPUTUM/URINE TESTS

OFFISTE BASELINE BLOOD DRAW CONSENT FOR NEXT HEALTH

“NextHealth” in the agreement below refers to all NextHealth employees, medical directors, owners and shareholders, including Dr Darshan Shah, CEO of NextHealth.

• • The procedure of a blood draw involves inserting a needle into a vein and drawing blood to send to a lab. This procedure may produce a bruise, phlebitis, or other local complication.
  • I understand that the place performing the lab is a contracted lab company and specimens must be sent to them for analysis. During this process there is a chance for delays, lost specimens, or incorrect results that are not the responsibility of NextHealth.
  • The blood or other specimen will be sent off site, and my personal information is collected by the lab for identification purposes.
  • Patient information is protected by HIPPA and is not shared with YPO or any other third parties.
  • I understand that my results of the test will be interpreted by a medical professional, and I consent to being contacted about my results. If I do not receive my results for any reason, it is my responsibility to contact the lab for the results and share them with my primary care physician.
  • The information provided is limited to the scope of the lab testing done. I understand that I must seek follow up from a primary care provider for any results of concern. NextHealth is not responsible for notification, diagnosis or treatment of any medical problems. .
  • I am responsible to share all results with my PCP and obtain clearance from my PCP for any further treatment, procedures, diet changes, or lifestyle change, supplement or medicine change, or any change I decide to make whatsoever.
  • I acknowledge that NextHealth will provide a review of my bloodwork.
  • I acknowledge that NextHealth and its employees are not my primary medical provider. NextHealth is only doing the blood test for example purposes.
  • If I do not have a primary care provider, I will seek one out immediately.
  • I am aware that other unforeseeable complications could occur. I do not expect the physician(s) and or other qualified staff members to anticipate and or explain all risk and possible complications.
  • I understand that all testing or interpretation done with NextHealth is not covered by insurance and I understand that if I submit an insurance claim for it, that I will be responsible for any and all non-covered services
  • I understand the risks and benefits of the procedure and have had the opportunity to have all of my questions answered.
  • I understand that I have the right to consent to or refuse any proposed treatment at any time prior to its performance. My signature on this form affirms that I have given my consent to lab testing with any different or further procedures which, in the opinion of my physician(s) and qualified staff members or others associated with this practice, may be indicated.

By selecting "I Agree to terms" on any of our digital communications confirms that: You understand these risks/benefits/alternatives, and are willing to accept all risks.