I understand that it is my responsibility to consult my own medical doctor for interpretation, analysis, evaluation, and explanation of my test result. I understand that neither InOut Labs nor its ordering physicians will analyze, evaluate, critique, review or otherwise interpret the result of these tests. I agree that InOut Labs its officers, shareholders, directors, contracted physicians, or its other agents or employees shall not be liable for any claims including, but not limited to, any claim arising out of the related to, inaccurate, un-interpreted, misinterpreted or result InOut Labs not received and do hereby expressly forever release and discharge all claims, demands, injuries, damage, actions or causes of action.
I certify that I am not a recipient of Medicare, Medicaid or any other government health insurance benefits, nor will I seek to be reimbursed by Medicare, Medicaid or any other government insurer/payor for the test(s) performed. I agree that I am personally financially responsible for payment of fees for all tests ordered and collected by InOut Labs at my request.
I understand that the tests that I have selected to be performed at InOut Labs are done at my request. I further understand that a contracted physician of InOut Labs who is licensed under Illinois law to order such testing will do so. I also understand that the actual testing may be performed by a third party laboratory, certified to perform such testing on my specimen collected by InOut Labs. I understand and agree that InOut Labs will report the result of the testing directly to me or to those I designate. I consent and authorize that such disclosure may be made by fax, mail, direct pick-up or by email. I understand and agree that the services provided by InOut Labs and the test result from the Lab will be maintained as confidential, protected health information by InOut Labs as required by Federal and State law.
I understand that the test results will become part of my medical record. I hereby consent to the release of my test results by InOut Labs to me in the manner I have chosen and my physician or any other healthcare provider or insurance company designate, or as otherwise required by law. I understand that my test results will only be provided to other third parties upon my express consent.
All of the above has been discussed with me and I have had an opportunity to have any questions answered that I may have regarding my rights to privacy by an employee of InOut Labs. I have received a copy of Notice of Privacy Practices, as required by HIPAA from InOut Labs or I have chosen not to receive a copy. I agree to take full financial responsibility for the cost of testing requested by me, and that payment is required prior to specimen collection.
I agree to receive occasional email communication from InOut Labs. We will never rent or sell your personal information to third parties, and you are free to opt out at any time.
I have read and agree to all the above terms.
