ATCG Lab
Opening hours
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الأحد
يوم عطلة
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الإثنين
09:00 - 21:00
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الثلاثاء
09:00 - 21:00
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الأربعاء
09:00 - 21:00
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الخميس
09:00 - 21:00
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الجمعة
09:00 - 21:00
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السبت
09:00 - 21:00
About the company
BY BOOKING THIS APPOINTMENT YOU ARE CONSENTING TO THE FOLLOWING:"I REQUEST AND AUTHORIZE ATCG LAB TO PERFORM THE DESIGNATED TEST(S) ON THE SAMPLE PROVIDED BY ME. MY SIGNATURE BELOW CONSTITUES MY ACKNOWLEDGEMENT THAT I HAVE BEEN INFORMED OF THE BENEFITS AND LIMITATIONS OF THIS TESTING WHICH HAVE BEEN EXPLAINED TO MY SATISFATION BY A QUALIFIED HEALTH PROFESSIONAL. I ALSO UNDERSTAND THAT REFERENCE TESTING LAB RESERVES THE RIGHT TO PROVIDE DE-IDENTIFIED INFORMATION OF A STATISTICAL NATURE TO ACCREDITING AGENCIES AND RESERVES THE RIGHT TO USE SUCH ANONYMOUS INFORMATION IN COMPLIANCE. ASSIGNMENT OF BENEFITS: I HEREBY AUTHORIZE MY INSURANCE COMPANY TO PAY THE COMPANY DIRECTLY FOR SERVICES RENDERED. APPEAL AUTHORIZATION: IN THE EVENT OF AN UNDERPAYMENT OR DENIAL BY MY INSURANCE CARRIER, I HEREBY AUTHORIZE THE COMPANY OR THEIR DESIGNEE TO APPEAL MY HEALTH PLAN ON MY BEHALF TO PROVIDE THE ACTIONS AND INFORMATION NECESSARY TO OVERTURN THE DENIAL OR RECEIVE REIMBURSEMENT FOR THE UNPAIDED CLAIM. THIS AUTHORIZATION SHALL REMAIN VALID UNTIL THE CHARGES FOR THE ORDERS ON THIS FORM ARE PAID IN FULL. DONOR SIGNATURE: I CERTIFY THAT I PROVIDED MY SPECIMEN TO THE COLLECTOR; THAT I HAVE NOT ALTERED IT IN ANY MANNER; EACH SPECIMEN USED WAS SEALED IN MY PRESENCE; AND THAT THE INFORMATION PROVIDED ON THIS FORM AND ON THE LABEL AFFIXED TO EACH SPECIMEN IS CORRECT. I AUTHORZE THE RELEASE OF THE RESULTS TO THE ORDERING CLINICIAN, AUTHORIZED CLIENT/REPRESENTATIVE, OR PRESCRIBING/ATTENDING PHYSICIAN. I AUTHORIZE ATCG LAB OR ITS AFFILIATES TO RELEASE ANY INFORMATION REQUIRED FOR BILLING PURPOSES. I ACKNOWLEDGE ATCG LAB OR ITS AFFILIATES MAY BE AN OUT OF NETWORK PROVIDER WITH MY INSURER. I ALSO AGREE THAT IN A CASE WHERE MY INSURANCE PROVIDER SENDS PAYMENTS DIRECTLY TO ME, I WILL ENDORSE THE INSURANCE CHECK AND FORWARD TO ATCG LAB WITHIN 30 DAYS. BY CHECKING THIS BOX. IF YOU ARE UNISURED, YOU ARE AUTHORIZING ATCG LABORATORY TO PERFORM THE REQUIRED TESTING INDICATED ABOVE. I ALSO AUTHORZE ATCG LABORATORY TO BILL THIS SERVICE TO THE CARES ACT PROVIDER RELIEF FUND FOR UNINSURED PATIENT IN ORDER TO COLLECT REIMBURSEMENT."Our team
ATCG Lab
ATCG Lab
Irvine, 18 TECHNOLOGY DR, SUITE 107
ATCG Lab
Top services
Rapid Antigen Test/ PCR
5 دقيقة
BY BOOKING THIS APPOINTMENT YOU ARE CONSENTING TO THE FOLLOWING:"I REQUEST AND AUTHORIZE ATCG LAB TO PERFORM THE DESIGNATED TEST(S) ON THE SAMPLE PROVIDED BY ME. MY SIGNATURE BELOW CONSTITUES MY ACKNOWLEDGEMENT THAT I HAVE BEEN INFORMED OF THE B
ATCG Lab
Irvine, 18 TECHNOLOGY DR, SUITE 107
Rapid Antigen Test/ PCR
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