I hereby grant permission to the Platte County Health Department to obtain speciments and to perform tests for sexually transmitted diseases. I also understand that I may be required to give identifying information, such as my Social Security Number, to the nurse when receiving results over the phone. I freely accept the medical and laboratory services provided to me. I am fully aware that all positive test results will be reported to the Missouri Department of Health and if HIV positive or TB positive, I will be offered management services. I also acknowledge that Platte County Health Department has offered me a copy of their "Notices of Privacy Practices".