I understand that test result s reported by ARCpoint Labs will be reported directly to me, in themanner I have chosen above. I further understand that it is my responsibility to consult my own medical professional for the interpretation, analysis, evaluation, and explanation of my test results. I understand that neither ARCpoint Labs nor its clinical authority will analyze, evaluate, critique, review, or otherwise interpret the results of said tests.

I agree that ARCpoint Labs, directors, staff, physicians, or its other agent or employee shall not be liable for any claims including, but not limited to, any claim arising out of or related to, inaccurate, un-interpreted, misinterpreted or results not received and do hereby expressly forever release and discharge all claims, demands, injuries, damage, actions or causes of action.

I will not seek to be reimbursed by Medicare, Medicaid, Tricare or any other government insurer/payor for the test(s) performed. I agree that I am personally financially responsible for payment of fees for all tests ordered and collected by ARCpoint Labs at my request.

 I understand that the tests performed at ARCpoint Labs are done at my request to be screened through either blood, urine or other testing matrix. I further understand that a physician employee of ARCpoint Labs who is licensed under state law to order such testing will do so. I also understand that ARCpoint Labs is a collection facility and that the actual testing will be performed by a third-party laboratory, certified to perform such testing on my specimen collected by ARCpoint Labs

I understand and agree that ARCpoint Labs will report the results of the testing directly to me, my physician, or any health professional that I request. I consent and authorize that such disclosure may be made by fax, by email or by direct pick-up. I understand and agree that the service provided by ARCpoint Labs and the test results from the Lab will be maintained as

confidential, protected health information by ARCpoint Labs as required by federal and state law.

 I understand that the test results may become part of my medical record. I also understand that  an insurance company may discover the results of this test by obtaining a copy of my medical record in accordance with the terms of my insurance policy(ies I hereby consent to the release of my test results by ARCpoint Labs to me in the manner I have chosen above and my physician or any other healthcare provider I designate. I understand that my test results will only be provided to other third parties upon my request.

All of the above has been discussed with me and I have had the opportunity to have any questions answered that I have regarding my rights to privacy by an employee of ARCpoint Labs. I have received a copy of Notice of Privacy Practices, as required by HIPAA from ARCpoint Labs or I have chosen not to receive copy.

chosen not to receive a copy.

I, the undersigned, authorize ARCpoint Labs to disclose or provide protected health information (laboratory results only) directly to me at the e-mail address I have provided above. I also understand that it is my responsibility to notify ARCpoint Labs of any change in this information. Any disclosure on e-mail is subject to the re-disclosure statement within this authorization.

I authorize ARCpoint Labs to disclose the protected health information, my lab results, to the e-mail address I have indicated above. This authorization is only effective for the visit date ("Date") listed on this form. You must submit a new authorization at each visit to ARCpoint Labs if you wish to have laboratory results sent to you by e-mail.

As stated in our Notice of Privacy Practice, I have the right to revoke or terminate this authorization by submitting a written request to the facility. This can be done in person or by mailing a request to the testing ARCpoint Labs.

RE-DISCLOSURE- I understand that ARCpoint Labs has no control over who may have access to the e-mail address I have listed to receive my protected health information. The information disclosed will no longer be protected by the requirements of the Privacy Rule and future discloser is not the responsibility of ARCpoint Labs.

Certain infectious diseases, conditions, and the identity of those who test positive for them, are required by federal and/or state law to be reported to local or state health authorities by your health care provider(s), including ARCpoint Labs, Clinical Authority Staff Physician, their staff, and the laboratories that run the medical tests. The time frames and reporting requirements vary according to the disease or condition

These local and state health authorities are considered Public Health Authorities according to the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) which means that they are legally authorized to receive your Protected Health Information (“PHI” However, both ARCpoint Labs and these health authorities will not otherwise share or release any confidential information, unless mandated by law or authorized by you in writing.

You understand that if you test positive for any infectious disease or condition on the state’s list of reportable conditions, your test result and your identifying information will be reported to the applicable local or state health authority.

Reporting this information does not require your permission or consent.

Additionally, you understand that if you test positive for any infectious disease or condition, neither ARCpoint Labs, nor its Clinical Authority Staff Physician, their staff, or the laboratories that run the medical tests, will treat, prescribe medications, or refer you for medical treatment. It is your sole responsibility to seek and comply with necessary treatment and all required follow-up with your physician or local public health department.

I understand that this test looks for antibodies to COVID-19, NOT the virus itself. Testing for viral DNA, via PCR analysis, is performed only in specifically designated places and on patients who meet a strict pre-test criteria. I am electing to have this antibody test to assess whether or not I have been exposed to the novel coronavirus in the past. I additionally understand that if I choose to have this test fewer than seven days after the resolution of symptoms, the results may be less reliable.

I hereby attest that I have been advised to take this test only as a completely asymptomatic individual. I have never had symptoms or at least have been symptom-free for seven days.

I also understand that the results of this test may be given to the department of health or CDC for their statistical and demographic value.

This test has not been reviewed by the FDA. Negative results do not rule out SARS-CoV-2 infection, particularly in those who have o been in contact with the virus. Follow-up testing with a molecular diagnostic should be o considered to rule out infection in these individuals. Results from antibody testing should not be used as the sole basis to diagnose or exclude o SARS-CoV-2 infection or to inform infection status. Positive results may be due to past or present infection with non-SARS-CoV-2 o coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E.