ADVANCE BENEFICIARY NOTICE
ABN - MEDICARE

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PRESENTED HERE ARE TWO ADVANCE BENEFICIARY NOTICE FORMS - ABN - MEDICARE REQUIRES THAT THIS FORM BE SIGNED BEFORE ANY BLOOD WORK CAN BEGIN.

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A fully signed Advance Beneficiary Notice (ABN) document is required by Medicare before submittal of your Blood test order will be processed. We present here different formats, from different companies. We have removed the names of the companies and other identifiable and personally identifiable information, for obvious reasons, Other than that, the forms are exactly as you will see them when your Physician fills them out and asks you to sign them.

These forms are presented here because we here at BloodBook.com firmly believe that you have a right to examine and to fully understand all information on the services that you are paying for. If you have reviewed these complex forms before you are asked sign them, you will be able to ask more informed questions about exactly what the forms mean to you. You will also feel better about your Blood donation and/or transfusion experience. These forms may have legal and financial consequences for you. They are important.

We have a detailed explanation of the Advance Beneficiary Notice (ABN) HERE.


Presented here in very small, fast loading versions, are typical Advance Beneficiary Notice (ABN) documents (appx. 34 KB). Please click on either image to view a near actual size image which can be more easily read. The larger images will take a while to load with a modem, since they are over 180 KB.

As your Blood test is ordered and before the work can begin, you are required to sign an Advance Beneficiary Notice. You see this required signature block on the front side of each form. We have a detailed explanation of the Advance Beneficiary Notice (ABN) HERE.


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SAMPLE ADVANCE BENEFICIARY NOTICE - 1

Click HERE to view LARGE ABN Notice.

SAMPLE ADVANCE BENEFICIARY NOTICE - 2

Click HERE to view LARGE ABN Notice.


ADVANCE BENEFICIARY NOTICE SAMPLE - 1
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ADVANCE BENEFICIARY NOTICE SAMPLE - 2

We apologize for the poor quality of these images. To put this in full perspective, the above presentation is reproduced in a state of the art graphics studio. Representations of the best of the original documents that we have available to us are published here. They are standard forms, available in the office of your physician, and are from the worlds largest Blood labs.

Cynically, this is a document that potentially obligates the patient to spend their own money. Please notice the very fine print. Please notice the very hard to read inexpensive paper and ink. These documents are unaltered by BloodBook.com, except as stated period-red.gif (63 bytes)

We have a detailed explanation of the Advance Beneficiary Notice (ABN) HERE.

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   last updated 11/10/2004   bloodbook.com