I understand that possible exposure to COVID-19 before/during/after my
treatment/procedure/surgery may result in any of the following:
a. a positive (+) COVID-19 diagnosis
b. extended quarantine/self-isolation
c. additional tests
d. hospitalization that may require medical therapy
i. intensive care treatment
ii. intubation/ventilator support
iii. short-term or long-term intubation
iv. other potential complications, including the risk of death
e. Additional care that may require me to go to an emergency room/hospital.