Data Protection. Consent to data transfer and discharge from the duty of (medical) confidentiality. I hereby give my consent for my personal data and treatment data to be collected, stored, processed and used. I also agree that my data, which are necessary for invoice processing (e.g. name, date of birth, address, date of treatment, service codes, invoice sums, treatment documentation) will be disclosed to “Academy of Nutritional Medicine (AONM), St. John’s Innovation Centre, Cowley Road, Cambridge CB4 0WS” and any relevat laboratory that will carry out the tests I have ordered whether this be in Europe, United States or any other part of the world for the purpose of the creation of invoices or for collection of receivables or – if necessary – for judicial enforcement. These are primarily, but not limited to ArminLabs, Zirbelstrasse 58. 2nd floor, 86154 Augsburg, Germany; Moleculera Labs, Inc., 755 Research Parkway, Suite 410, Oklahoma City, OK 73104; Laborpraxis Dr. Pachmann, Arzt für Transfusionsmedizin, Kurpromenade 2, 95448 Bayreuth, Germany.
This declaration of consent can be revoked at any time with effect for the future. In this respect I release any treating practitioner, AONM and ArminLabs and their employees from their obligation of (medical) secrecy. I also agree that the laboratory results, which are obtained within the scope of this laboratory order, will be disclosed to my treating practitioner.
I have been fully informed of the scope and the costs of these laboratory tests, in particular that I have to obtain a Treatment Guaranty from my health insurance scheme or that I have to bear the costs, which means that the costs are not or not fully met by a third party. The entitlement to remuneration is exclusively directed against the patient or the invoice recipient and is not dependent on a potential payment by a third party. I am aware that the required laboratory services are not services of the social security carriers, therefore the costs are normally not borne by the health insurance scheme, health insurances or subsidy offices. I am also aware that my physician is entitled to invoice his services (i.e. not services listed in this laboratory order) additionally. The medical/laboratory tests will be invoiced in accordance with the scale of charges for doctors. In full knowledge of these facts I hereby declare that the laboratory tests, as indicated above, subsequent to my request shall be carried out.
AONM may assist and guide patients and practitioners with regards to which tests are appropriate to take but I understand that any tests taken through AONM do not constitute a medical diagnosis on the part of AONM. AONM makes no claims whatsoever to be able to diagnose medical conditions but to provide tests which can help to form the basis of a diagnosis which must be done by qualified practitioners.