Gentle Hands Mobile Phlebotomy Services
Please read the following Terms and Conditions carefully. By signing this document, you acknowledge that you have read, understand, and agree to the policies of Gentle Hands Mobile Phlebotomy Services (GHPS).
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GHPS is responsible for the collection and transportation of laboratory specimens. We will only collect specimens with a valid physician's order or laboratory requisition. GHPS does not diagnose, treat, or provide medical advice.
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Patients Initials
To ensure a smooth appointment, please provide the following at least 24 hours before your appointment: Patient demographic information and Valid laboratory requisition or physician's order
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Patients Initials
GHPS delivers collected specimens to the designated laboratory. Once specimens have been transferred to a laboratory or third-party courier, GHPS is not responsible for delays beyond our control.
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Patients Initials
GHPS is not responsible for laboratory processing errors after delivery. If recollection is required due to a GHPS error and all documentation was properly submitted, recollection will be completed at no additional charge
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Patients Initials
Payment is due prior to your appointment. GHPS does not bill insurance companies. Patients are responsible for requesting reimbursement from their insurance carrier if applicable.
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Patients Initials
Patients are responsible for resolving any outstanding laboratory balances prior to collection if required by the laboratory
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GHPS is an independent mobile phlebotomy service and is not affiliated with any physician's office, hospital, or laboratory.
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GHPS is committed to protecting your privacy and will only disclose information as permitted or required by law.
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Patients Initials
GHPS does not receive laboratory test results. Please contact your ordering provider regarding your results.
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Please provide at least 24 hours' notice to cancel or reschedule. Appointments canceled with less than 24 hours' notice may be subject to a $25 rescheduling fee.
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Questions or concerns may be directed to GHPS by phone, text message, or email.
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Please ensure pediatric patients are well hydrated for at least 24 hours before the appointment whenever medically appropriate.
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Patients Initials
GHPS will make every reasonable effort to obtain the specimen with a single venipuncture. Up to two attempts may be necessary depending on vein condition.
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Patients Initials
If the patient has a history of aggressive or combative behavior during blood draws, please notify GHPS before the appointment so appropriate accommodations can be made.
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Patients Initials
I certify that I have read and understand the Terms and Conditions above. I have had the opportunity to ask questions and voluntarily consent to receive mobile phlebotomy services from Gentle Hands Mobile Phlebotomy Services (GHPS), or I authorize services on behalf of my minor child or dependent.
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Relationship to Patient (if applicable):
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