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I have been informed that an oral sample from my mouth will be tested for antibodies to the Human Immunodeficiency Virus, the virus that causes AIDS.
I acknowledge that I have been given an explanation of the test, including it's uses, benefits, limitations, and the meaning of the test results.
I have been informed that the HIV test results are confidential, and shall not be released without my written permission, except as required under state law.
This test will be performed confidentially. I understand that my Personally Identifying Information will be provided to the Michigan Department of Health and Human Services regardless of result.
I understand that I have the right to withdraw my consent for the test at any time before the test is complete.
I acknowledge that I will be provided with a copy of the pamphlet "What You Need to Know about HIV Testing." I will be given the opportunity to ask questions concerning the test for HIV antigens and/or antibodies, and I understand that my questions will be answered by the test counselor.
I understand that I will be contacted by a Corktown Health test counselor for follow-up.
A signed copy of this consent form will be included with my test kit.
By my signature below, I consent to be tested for HIV