• St. Francois County Health Center

    COVID-19 Test Registration & Consent
  • Health History

  • Please read carefully the following notice & sign the authorization to test for COVID.

    1. I understand that the COVID-19 testing will be conducted with a BinaxNow or Acon FlowFlex antigen test.

    2. I understand that I am not creating a patient relationship by participating in this testing. I understand SFCHC is not acting as my medical provider. Testing does not replace treatment by my medical provider. I assume complete & full responsibility to take appropriate action with regards to my test results & medical care. I agree I will seek medical advice, care & treatment from my medical provider or other healthcare entity if I have questions or concerns, or if I develop symptoms of COVID-19, or if my condition worsens. 

    3. I understand it is my responsibility to inform my healthcare provider of a positive test result, and that a copy will not be sent to my healthcare provider.

    4. I understand & acknowledge that a positive antigen test result is an indication that I need to self-isolate to avoid infecting others.

    5.  I understand & acknowledge that if I am symptomatic & receive a negative antigen result, it is recommended to consider confirmatory testing with a PCR.

    6. I have been informed of the test purpose, procedure and potential risk & benefits. I have had the opportunity to ask questions before proceeding with the test. 

    7. I understand that I may withdraw my consent to participate in testing at any time. 

     

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