By signing this form, I agree to the following:
a. I authorize this COVID-19 testing unit to conduct collection and testing for COVID-19 through a nasopharyngeal swab (a swab in the nose) or an oral swab (a swab in the throat).
b. I authorize my test results to be disclosed to the Florida Covid19 Reporting Portal.
c. I acknowledge that a positive test result is an indication that I should self-isolate and wear a mask or face covering as directed.
d. I understand the Family Care Pharmacy is not acting as my c medical provider, this testing does not replace treatment by my medical provider, and I assume complete and full responsibility to take appropriate action when I receive 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 worsens.
e. I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.
f. I understand that there will be a $99.00 charge for this test payable over the phone at 813-659-9777. Calling hours are 9am to 6pm Monday to Friday only.
I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of this Informed Consent and the Notice of Privacy Practices.