I authorize Goodside Health or an appropriate school representative to conduct COVID-19 testing and approve the collection of a sample or samples through a nasal swab for the purpose of that testing.
- I acknowledge and understand that there are risks and benefits associated with undergoing a COVID-19 test, and there is the potential for false positive or false negative test results. The COVID-19 test being administered does not provide a medical diagnosis of COVID-19 or any other disease. The test result provides information for your healthcare provider to assist in determining whether you should receive further testing or medical treatment.
Further, I understand that the COVID-19 tests administered by Goodside Health or an appropriate school representative have not been cleared or approved by the U.S. Food and Drug Administration (“FDA”) but have been authorized under an emergency use authorization granted by the FDA. I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have any questions or concerns regarding my results, I shall promptly seek advice and treatment from an appropriate medical provider. - I understand that I will receive the test results from Goodside Health, its affiliates, or an appropriate school representative unless I direct otherwise. I understand that I have a right to confidential treatment of my test sample and test results and that my test results will only be disclosed as authorized in this consent or as allowed under applicable law. I understand that by providing an email address, I may receive test results via email.
- Test results will be maintained in accordance with applicable laws. I understand that only Goodside Health or an appropriate school representative will have access to my sample(s) and that my sample(s) will be used only for the purposes for which I have given my consent or as allowed under applicable law. Samples will be destroyed after the date of testing.
- I understand and acknowledge that Goodside Health, its affiliates, representatives and agents or an appropriate school representative are administering COVID-19 testing services only and are not providing any medical or other healthcare services. I understand that if healthcare services are needed or desired, I must seek such healthcare services from a healthcare provider of my own choosing.
Patient’s Statement: I, the undersigned, have been informed about the COVID-19 test’s purpose and possible risks and about the privacy rights and limitations applicable to the test. I have received a copy of this consent. I have been given the opportunity to ask questions before I sign. I voluntarily agree to receive rapid COVID-19 testing.