PROFESSIONAL SERVICES AGREEMENT
Specimen Collection & Clinical Laboratory Services
The Provider: Burgeon Medix, a Georgia Clinical Laboratory (NPI: 1134079973 (Burgeon Medix)), located in Snellville, GA.
1. Scope of Services
Burgeon Medix agrees to provide the following clinical services to the Client’s patients upon receipt of a valid physician’s order:
- Phlebotomy & Specimen Collection: Venipuncture and capillary collection for clinical testing.
- Specialized DNA Collection: AABB-certified legal and relationship DNA sample collection.
- CLIA-Waived Testing: On-site rapid testing (e.g., Strep, Flu, RSV, COVID-19, Urinalysis).
- Pediatric Care: Specialized lead testing and specimen collection for patients aged 0–2 years.
- Logistics: Secure transport of specimens to the laboratory of the Client’s choice or a Burgeon Medix affiliated reference lab.
2. Burgeon Medix Responsibilities
- Compliance: Maintain a current NPI, CLIA Waiver, and AABB certification.
- Clinical Standards: All collections will be performed by a certified phlebotomist in accordance with CLSI Standards and Georgia state regulations.
- Specimen Integrity: Burgeon Medix is responsible for the labeling, handling, and timely transport of specimens to ensure clinical viability.
- Medical Waste: Burgeon Medix will manage and dispose of all biohazardous waste generated during the collection process per OSHA standards.
3. Client (Physician/Facility) Responsibilities
- Physician Orders: Provide a signed, medically necessary requisition for every patient.
- Patient Information: Provide necessary demographic and insurance information required for laboratory processing.
4. Billing and Compensation
Choose the option that fits your specific deal:
- Option A (Insurance Billing): Burgeon Medix will bill the patient’s insurance directly for the collection fee (CPT 36415). The Client incurs no cost.
- Option B (Client Bill): The Client will pay Burgeon Medix a flat fee of $[Amount] per successful collection. Invoices are payable within 30 days.
5. HIPAA and Confidentiality
Both parties agree to adhere to all HIPAA and HITECH regulations. Burgeon Medix will maintain strict confidentiality of Protected Health Information (PHI) and will only share results with the ordering physician as authorized by law.
6. Term and Termination
- Term: This agreement is for an initial period of one (1) year and shall automatically renew.
- Termination: Either party may terminate this agreement with 30 days’ written notice for any reason.
7. Liability and Insurance
Burgeon Medix shall maintain professional liability (malpractice) insurance with limits of at least $1,000,000 per occurrence.