Blood Profile Pre-Registration Consent
Please read carefully and sign below.
The Annual Health Fair blood profile includes the following tests: glucose, potassium, BUN, creatinine, GFR, calcium, alkaline phosphatase, total protein, albumin, AST, total cholesterol, triglycerides, HDL, LDL, and cholesterol ratios. The PSA (prostate specific antigen) test is optional for Males Only. For males wishing that this test be included, the request must be made while completing the registration paperwork and prior to the time the blood is drawn. There is an additional fee for the PSA test. I understand that no additional individualized test can be included in the Health Fair profile blood tests.
Results are reviewed by an LMH Health pathologist. The results and a cover letter are mailed to the participant as soon as reasonably possible but in most cases will take about 3-4 weeks, after the Fair, to be mailed. I understand that if my identifying information as noted below, including name, address, gender, and birth date, are not fully complete nor legible, the blood profile results may not be able to be correctly processed nor mailed to me. I also understand that results will not be released or mailed to anyone other than myself (including my personal physicians).
I give my consent to LMH Health Lab to draw blood from me for the Annual Health Fair blood profile. I agree that LMH Health Lab and its staff will not be held responsible for any injuries, including bruising, incurred during the blood drawing process. I understand the responsibility for initializing any follow-up examinations for any abnormalities identified by these test lies with me as the person responsible for my own health and not with LMH Health Lab. I also understand that on occasion, my blood sample may hemolyze (red blood cells can be destroyed) during the blood drawing or analysis processes, and therefore can alter results, and if so, I may be contacted to come back into LMH Health Lab to have my blood redrawn.