Consent, Confidentiality, & HIPPA
Each patient is asked to sign the following Consent & Confidentiality Aggreement
The advantages, nature, and purpose of autologous platelet rich plasma application, the risks involved, and the possibility of any complications have been explained to me.
I consent to the withdrawal of blood by authorized staff and/or associated of By The Blood, Inc. for autologous transfusion process, and further consent to such additional procedures pursuant of autologous platelet rich plasma.
Should I not require re-transfusion of the blood withdrawn for autologous transfusion, I further consent to the disposal of my blood in an appropriate manner.
I consent to any pictures that may be taken during my procedure may be used for teaching purposes or publications as deemed appropriate by my physician.
I consent that any pictures that may be taken before, during, or after my procedure may be used for teaching or publications (to include brochures and/or internet) as deemed appropriate by By The Blood, Inc.
I consent that By The Blood, Inc. may retain a copy of records and documents related to this consent for administrative and legal purposes.
By The Blood, Inc. and HIPPA
By The Blood, Inc. considers maintaining the security and confidentiality of protected health information (PHI) a matter of its highest priority. All those granted access to this information must agree to the standards set forth in the privacy information agreement. All those who cannot agree to these terms will be denied access to protected health information (PHI) entrusted by our patients to our practice. Each person accessing By The Blood, Inc.'s data and resources holds a position of trust relative to this informationa and must recognize the responsibilities entrusted in preserving the security and confidentiality of this information. The following conditions apply to all those having access to protected health information.
By The Blood, Inc. has written and verbal permission from all participants that have consented to have their case studies published to the website. By The Blood, Inc. uses these pictures for educational and promotional purposes with no ill will towards the individuals involved. At any time a patient decides they do not wish their pictures to be published to the website and request they be removed By The Blood, Inc. will remove them within twenty four hours of notice via email: rikihelms@bytheblood.com.
