I authorize the collection and testing for COVID-19 through an oropharyngeal (throat), nasal, and/or nasopharyngeal swab, as ordered by an authorized medical provider/public health official.
By voluntarily agreeing to this testing, I understand that my test results will be disclosed to the county, state, or any other government entity as may be required and/or permitted by law, and that my test results will be reported to the operator of my facility.
I understand that Pine Plains Pharmacy employees, volunteers, and contractors, who are collecting specimens and providing test results. This specimen collection and testing does not replace treatment by my medical provider. I assume complete and full responsibility to take appropriate action with regard to my test results. I agree I will seek medical advice, care, and treatment from my medical provider if I have questions or concerns, or if my condition worsens.