• COVID-19 Rapid Antigen Test Waiver

  • I understand and agree to the following terms and conditions:

    COVID-19 rapid antigen tests are considered most accurate in a patient who is having symptoms of COVID-19. I UNDERSTAND that it is possible for the COVID-19 rapid antigen tests to give a negative result that is INCORRECT (false negative) in some people with COVID-19 and that Alzein Medical LTD (DBA Alzein COVID Testing Center) is not responsible for such a result.

    I UNDERSTAND that a negative COVID-19 rapid antigen test result only reflects the point in time that the sample was taken and that I must continue to practice safe hygiene and follow other public health directives regardless of my test results.

    I ASSUME complete and full responsibility to take appropriate action with regards to my own health and the COVID-19 rapid antigen test results.

    I UNDERSTAND that testing does not replace treatment by my personal healthcare provider.

    I UNDERSTAND that if my COVID-19 rapid antigen test result is negative, Alzein Medical LTD (DBA Alzein COVID Testing Center), will NOT be able to provide work release or travel release documentation until my PCR molecular test results are finalized.

    I AUTHORIZE Alzein Medical LTD (DBA Alzein COVID Testing Center) to collect a nasopharyngeal swab(s) (or other appropriate test samples) from me.

    I AUTHORIZE Alzein Medical LTD (DBA Alzein COVID Testing Center) to conduct a COVID-19 rapid antigen test and to release the results of such test to me and to communicate with local, state, and federal health agencies as appropriate and required by law.
     
    I UNDERSTAND that test results reported by Alzein Medical LTD (DBA Alzein COVID Testing Center) will be reported directly to me.
     
    I AUTHORIZE Alzein Medical LTD (DBA Alzein COVID Testing Center) to follow up with me regarding my test results either by telephone or by telemedicine.

    I AGREE to sign any forms required by Alzein Medical LTD (DBA Alzein COVID Testing Center) to release my test results to any third party and AUTHORIZE Alzein Medical LTD (DBA Alzein COVID Testing Center) to communicate with state, local, and federal public health agencies, about my test results as appropriate or required.

    In consideration of the testing and follow up medical services being provided to me, I RELEASE Alzein Medical LTD (DBA Alzein COVID Testing Center), their respective officers, directors, agents, and employees, from any and all claims that I might have due to the testing, results and/or follow up medical services, including but not limited to the testing process, the testing results, or results not received, and follow up medical services.

    I AGREE not to file any action at law against Alzein Medical LTD (DBA Alzein COVID Testing Center), their respective officers, agents or employees in connection with any aspect of the COVID-19 rapid antigen test or follow up medical services and to hold Alzein Medical LTD (DBA Alzein COVID Testing Center) harmless from any damages, attorneys’ fees, or expenses related in any way to my participation in the testing.

    By signing below, I agree and confirm that I HAVE READ AND UNDERSTAND the terms and conditions contained herein, that these terms and conditions are in addition to those included in the COVID-19 Testing Centers Waiver & Consent that I have already executed, and that I CONSENT to a COVID-19 rapid antigen test and follow up medical services. This COVID-19 Rapid Antigen Test Waiver shall continue in effect until containment of COVID-19 as determined by federal, state, and local government agencies.

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