North Carolina Release regarding Laboratory Activities

State:
Multi-State
Control #:
US-0762-WG
Format:
Word; 
Rich Text
Instant download

Description

This form states that the participant is assuming responsibility for his voluntary participation in an activity. The release acts as an assurance to the person requesting the release that they will not be subjected to litigation resulting from the signing party's informed and consensual acts. If the particpant is under the age of 18, a parent or guardian's signature is required.

How to fill out Release Regarding Laboratory Activities?

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FAQ

For patient safety, each Laboratory Requisition is only valid for 6 months after the date that it was authorized. Incomplete, unauthorized, or illegible forms cannot be processed by the community laboratory, cannot be claimed, and is not eligible for payment. 1.

Our GPs are not able to take phone calls from patients regarding test results (as they are busy seeing patients throughout the day), so you will need to book an appointment with a GP if you want to discuss your test result.

Clinical laboratories may release test results to the physician or practitioner who ordered the test as well to as the patient. However, laboratories may not release test results to others without the written permission of the patient see D.C. Code Ann. 44-211 (2008) and N.H.

Will I receive an identifying CLIA number? You will receive a ten-character alpha-numeric code on the CLIA certificate. This number will be utilized to identify and track your laboratory throughout its entire history. You should use this number when making inquiries to the State Agency and CMS about your laboratory.

Does my requisition expire? Requisitions do not expire, however if your Healthcare Provider has closed their practice or moved their office, it is recommended to obtain a new requisition.

If a result is sufficiently abnormal to cause any immediate medical concerns the doctor will contact you themselves. If a doctor wants to discuss a test result where there is no significant level of concern, they may ask reception to book you in for a routine telephone call.

Requisitions do not expire, however if your Healthcare Provider has closed their practice or moved their office, it is recommended to obtain a new requisition.

The pathologist has the ultimate responsibility for the test results, the quality and safety standards of the laboratory, advising clinicians on the interpretation of test results and the further investigation of the patient.

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North Carolina Release regarding Laboratory Activities