USN COVID-19 Testing Consent
University School of Nashville has partnered with Genetic Assays, a high complexity molecular diagnostics laboratory licensed by the state of Tennessee, to perform COVID-19 testing on students, faculty, staff and/or immediate family members as needed. This should enable us to receive results more quickly and conveniently than available through other testing sites in the community.

Health insurance plans are required to provide coverage and payment without any additional costs to patients, such as copays or deductibles (Section 6001 of the Families First Coronavirus Response Act, amended by Section 3201 of the Coronavirus Aid, Relief, and Economic Security Act). USN is not involved financially in this process.

The tests will be administered by Jennifer Aaron, NP, Amy Harkness, RN, and Margee Brennan, MD, who will also act as the ordering physician. Should you or your student test positive for COVID-19, please contact your primary care physician for further direction and treatment. USN Health Team staff will provide testing but not clinical evaluation or treatment of COVID-19.

Test results will be communicated to you at the phone number given below. Please do not contact Genetic Assays for lab results.
Sign in to Google to save your progress. Learn more
Patient's Full Name *
Home Address, Including City, State & ZIP Code *
Patient's Date of Birth *
Patient's Sex *
Parent/Guardian's Full Name *
Parent/Guardian's 10-Digit Phone Number *
Parent/Guardian's Email Address *
Clear form
Never submit passwords through Google Forms.
This form was created inside of University School of Nashville. Report Abuse