· I authorize this COVID-19 testing to be conducted through a nasopharyngeal or nasal swab.
· I understand the entity performing the test is not acting as my medical provider. I agree I will seek medical advice, care, and treatment from my medical provider or other health care entity in my area if I have questions or concerns, if I develop symptoms of COVID-19, or if my condition worsens.
· I understand that I will obtain my test results through an electronic portal. It is my responsibility to provide a copy to my health care provider if needed.
· I authorize Helix Diagnostics to release my test results to the Kent County Health Department and the Michigan Department of Health and Human Services.
· I verify that the information that I have provided on this form is accurate.
Helix Diagnostics COVID-19 Informed Consent *
Signature of Informed Consent (Patient Name or Guardian) *
Date of Informed Consent *
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