I hereby acknowledge that the specimen provided is my own and has not been adulterated. I acknowledge MD Diagnostic Labs to share my test results with the Texas State University Student Health Center for weekly test reporting. I also understand that it is my responsibility to consult my own medical professional for further diagnosis/ follow up. I understand and agree that Test results will be maintained as confidential, protected health information ("PHI") by MD Diagnostic Labs as required by federal and state law. I understand that the Test results will become part of my medical record. If under CARES ACT, I certify that I do not have medical insurance.
I certify and agree that all the above information is correct.