Orascoptic DK™
Disclaimer on Customer Use of Patient Financial Responsibility Form
The Patient Financial Responsibility Form should be used by you solely in connection with having your patient accept financial responsibility for the Orascoptic DK exam. The form is not intended to be used, nor meets any legal requirements necessary, (i) for a patient to provide informed consent to the exam, or (ii) submission of any claim under Medicare or Medicaid, or any state equivalents. Kerr Corporation disclaims any and all responsibility for your compliance with state informed consent requirements and the Medicare and Medicaid requirements.