PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY
I authorize the UITCT COVID-19 testing unit to conduct collection and testing for COVID-19 through a nasopharyngeal swab, as ordered by an authorized medical provider or public health official.
I authorize my test results to be disclosed to the county, state, or to any other governmental entity as may be required by law.
I acknowledge that a positive test result is an indication that I must continue to self-isolate in an effort to avoid infecting others.
If a positive test result is received UITCT has my consent to contact persons who have been in close contact and may have been exposed to COVID-19.
I understand that, as with any medical test, there is the potential for false positive or false negative test results can occur.
Please sign below that you have read and consented to these statements.
UITCT will not, under any circumstances, share your personal information with other individuals or organizations without your permission, including public organizations, corporations, or individuals, except when applicable by law.