Waiver of Liability and Release of Information
WAY OUT WEST MOBILE PHLEBOTOMY LLC LICENSED & INSURED
PHONE 928-232-0459 Fax 928-685-3376
Way Out West Mobile Phlebotomy LLC is a private pay, mobile, blood drawing, service. It is our mission to provide convenient, safe, professional, care. A certified phlebotomist will come to your home, facility, office, or designated area for a venipuncture blood draw (s). Services include transportation of specimen(s) at required temperature to the preferred laboratory or currier.
Mobile Services are unable to be billed through insurance. Our Services are strictly private pay. It is very important however, that you submit a copy of your insurance card (front and back), as well as your lab order. All lab orders must be signed by a physician. Lab orders must also have diagnosis codes provided. The preferred laboratory where your specimens will be delivered and processed at will need this information to bill your insurance properly for the laboratory testing. Lab requests, and insurance information can be submitted to Way Out West Mobile Phlebotomy, LLC via fax, or email.
Way Out West Mobile Phlebotomy, LLC is HIPPA certified and compliant. We provide services to strictly follow all HIPAA privacy terms and regulations. Under no circumstance will Way Out West Mobile Phlebotomy LLC give out client’s personal information to unauthorized personnel.
Lab results are sent directly to the ordering provider by the preferred laboratory. If you have any questions or concerns related to your pending lab results please contact your provider’s office. Way Out West Mobile Phlebotomy LLC does not have access, nor will we receive your lab test results. Our services are here to provide mobile phlebotomy services only.
Way Out West Mobile Phlebotomy LLC is not responsible for any errors that may occur after being delivered to the preferred laboratory/currier. Please be advised that Way Out West Mobile Phlebotomy LLC is not responsible for any outstanding balances you may have with the preferred laboratory your specimens will be processed at. Laboratories do have the right to decline the specimen (s) of a patient that may have an outstanding balance.
Please be considerate, in the event an appointment needs to be cancelled. Way Out West Mobile Phlebotomy LLC needs to be given an 8-hour notice prior to your scheduled appointment. This is to avoid any rescheduling fees.
Please make sure to Prepare for your blood work. If you are uncertain of fasting or have any questions about prepping for your lab work, please reach out to your providers office. Any special instructions need to be clarified prior to making an appointment with Way Out West Mobile Phlebotomy LLC.
It is important to keep pressure applied after a venipuncture blood draw for approximately 15 to 20 minutes. I acknowledge that after a venipuncture blood draw, bruising can occur (All supplies used by Way Out West Mobile Phlebotomy LLC are latex free).
Way Out West Mobile Phlebotomy LLC has the right to refuse treatment at anytime. Any type of harassment will not be tolerated and a phlebotomist can and will leave the premises immediately.
I have read and understand all terms and conditions affiliated with Way Out West Mobile Phlebotomy LLC. I have addressed all questions and concerns I may have prior to signing this form of consent. I give full authorization to Way Out West Mobile Phlebotomy LLC to perform services including, venipuncture blood draw, access to patient/client information, and transportation of specimens(s) to the preferred laboratory/courier.