NOTICE:
This
doctor’s office is regulated pursuant to the rules of the Board of
Medicine as set forth in Rule Chapter 64B8, F.A.C.
CONSENT FOR TREATMENT:
The
patient or their representative, recognizing the need for medical
care, consents to the services as ordered by the South Florida Bone
Marrow/Stem Cell Transplant Institute including anesthesia, laboratory
procedures, medical or surgical treatment, x-ray examination, or other
medical services rendered under the general and specific instructions
of South Florida Bone Marrow/Stem Cell Transplant Institute.
RELEASE OF INFORMATION:
The South Florida Bone Marrow/Stem Cell
Transplant Institute is authorized to furnish information from the
patient's medical record to any insurer, compensation carrier, or
welfare agency who may provide financial assistance for medical care.
In addition, medical information is provided to the Autologous Blood
and Marrow Transplant Registry regarding medical treatment.
PERSONAL VALUABLES:
The
South Florida Bone Marrow/Stem Cell Transplant Institute shall not be
liable for any lost, stolen or damaged personal property of the
patient brought into the South Florida Bone Marrow/Stem Cell
Transplant Institute.
PHYSICIANS:
The
patient understands that any consultant is not an employee of nor
acting as an agent of the South Florida Bone Marrow/Stem Cell
Transplant Institute; nor is the South Florida Bone Marrow/Stem Cell
Transplant Institute liable for their actions.
______________________________________________________________________________