COVID-19 TESTING - INFORMED CONSENT & NOTICE OF PRIVACY PRACTICES
I authorize Olden Pharmacy and/or ATVIVO Laboratory to collect and test for COVID-19 (SARS-COV-2) through a nasopharyngeal, nasal, or oralswab, as ordered by an authorized pharmacist. I also understand that this procedure is semi-invasive and I may experience mild pain and discomfort and possible bleeding. I understand that this test detects if the SARS-COV-2 (the virus that causes COVID-19) is present at the time of testing only. It does not test for immunity or if the virus has been present in the past. I understand that Olden Pharmacy and/or ATVIVO Laboratory are not acting as my medical provider, this testing does not replace treatment by my medical provider, and I assume complete and full responsibility to take appropriate action with regards 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 persists or worsens. I understand that, as with any medical test, there is potential for a false positive or false negative COVID-19 test result. I authorize my information and results to be shared with the county, state or any other governmental entity which is required by law for COVID-19 tests.
I have received and understand Olden Pharmacy's Notice of Privacy Practices written in plain language. The notice provides in detail the uses and disclosures of my protected health information that may be made by Olden Pharmacy, my individual rights, how I may exercise these rights and Olden Pharmacy's legal duties with respect to my information. I understand that this practice reserves the right to change the terms of its Notice of Privacy Practices, and to make changes regarding all protected health information resident at or controlled by Olden Pharmacy. If changes to the policy occur, Olden Pharmacy will provide me a revised Notice of Privacy Practices upon request.