![]() ![]() I understand that this test result is required by Arizona Administrative Code (R9-4-302 and 404.H. Sonora Quest Laboratories may share the test results with my physician upon request, insurance provider, or other providers or as required by law. I understand that I will receive the testing results. I do not have a physician order for these tests. I am requesting this testing through the standing order provided by Sonora Quest Laboratories, powered by My Lab ReQuest. I understand that refunds will be processed 12-15 business days from my order expiration date. If I have an outstanding balance with Sonora Quest Laboratories from a separate date of service and my My Lab ReQuest order expires, I authorize Sonora Quest Laboratories to apply applicable refund toward that balance, with any remaining refund, if available, being processed. If I do not visit a Sonora Quest Laboratories Patient Service Center for sample collection or submit an at-home collection kit within 90 days of placing a My Lab ReQuest order, I understand that, if applicable, the prepaid amount will be automatically refunded in accordance with the refund policy. I release from liability and will not hold Sonora Quest Laboratories LLC or its Medical Director responsible if I do not promptly communicate the results of these tests to my physician. I understand that it is solely my responsibility to promptly discuss all laboratory results with a physician and that neither Sonora Quest Laboratories nor its Medical Director will provide interpretation, counseling, consultation, or care recommendations on the basis of any laboratory results provided to me. I further understand that these tests are not covered by Medicare as Medicare does not cover laboratory testing without a physician order. I understand that Arizona law prohibits laboratories from billing health insurance for patient ordered laboratory testing. If I am requesting testing for which a minor is required by law to consent, the minor has consented to such testing. If < 18, I am an emancipated minor or otherwise authorized to request and provide consent for the tests ordered below. If I receive a positive test result for a sexually transmitted disease or tuberculosis, I understand it is my responsibility to consult with my doctor and/or contact my county health department’s STD clinic or main office. For selected results marked with a bell icon on the test menu, a local or state public health investigator may contact me for additional information or to ensure proper treatment. and R9-6-204) to be reported to the Arizona Department of Health Services (AZDHS) for public health reasons. I understand that certain patient test results are required by Arizona Administrative Code (R9-4-302 and 404.H. Sonora Quest Laboratories may share the test results with my physician or other providers only in critical or emergent situations or as required by law. I understand that only I will receive the testing results. I am requesting Direct Access Testing through My Lab ReQuest. Please note that if you have an outstanding balance with us from a separate date of service and your My Lab ReQuest order is eligible for a refund per our refund policy, your refund will be applied toward that balance, with any remaining refund, if available, being processed. If you choose not to proceed with your at-home testing, we ask that you dispose of your kit(s). Orders for at-home kits are not eligible for a refund, however, you can still cancel the order. Orders that are $20 or less are not eligible for a refund, although you may still cancel the order, which will also cancel your corresponding appointment. There is a nonrefundable cancellation fee of $20 which will be deducted from your refund for orders greater than $20. You have 90 days to cancel your online purchase prior to sample collection at a Sonora Quest Patient Service Center. In-Person in Sonora Quest Patient Service Centers Uninsured patients have the option of paying a reduced cost of $100 if paid at the time of service or $120 if billed post-testing. We continually look to expand this menu and will take your request into consideration. Thank you for submitting your request for us to add new testing to our My Lab ReQuest menu. Please try changing your search parameters or complete the form below to suggest an addition to our My Lab ReQuest test menu. I understand that Sonora Quest Laboratories will notify me by phone of any critical result upon completion of testing, at any time of the day or night. I understand that certain abnormal test values are considered “critical” because they may (but do not necessarily) indicate the presence of a potentially life threatening condition requiring immediate medical attention. Select a test category to view available tests.
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