INFORMED CONSENT FOR COVID-19 DIAGNOSTIC TESTING
1. Authorization and Consent for COVID-19 Diagnostic Testing: I voluntarily consent and authorize The Testing Co. and Authorized Diagnostic Laboratory to conduct collection, testing, and analysis for the purposes of a COVID-19 Diagnostic Rapid/PCR Test. I acknowledge and understand that my COVID-19 diagnostic test will require the collection of an appropriate sample by my healthcare provider through a nasopharyngeal swab, anterior nares swab, or other recommended collection procedures. I understand that there are risks and benefits associated with undergoing a diagnostic test for COVID-19 and there may be a potential for false positive or false negative test results. I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have questions or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider. I attest that I have been asked for ID and Insurance, and I have provided all accurate information to the best of my knowledge.
2. Patient Rights and Privacy Practices
Notice of Privacy Practices and Patient Rights: Notice of Privacy Practices describes how it may use and disclose your protected health information to carry out treatment, initiate and obtain payment, conduct health care operations and for other purposes that are permitted or required by law. I acknowledge that The Testing Co. and Authorized Diagnostic Laboratory has provided me with a copy of Notice of Privacy Practices.
Disclosure to Government Authorities: I acknowledge and agree The Testing Co. and Authorized Diagnostic Laboratory may disclose my test results and associated information to appropriate county, state, or other governmental and regulatory entities as may be permitted by law.
3. Release: To the fullest extent permitted by law, I hereby release, discharge and hold harmless, The Testing Co. and Authorized Diagnostic Laboratory, including, without limitation, any its respective officers, directors, employees, representatives and agents from any and all claims, liability, and damages, of whatever kind or nature, arising out of or in connection with any act or omission relating to my COVID-19 diagnostic test or the disclosure of my COVID-19 test results.
By selecting the ACKNOWLEDGEMENT during the registration process for COVID-19 Collection and Diagnostic Testing, I acknowledge and agree that I have read, understand, and agreed to the statements contained within this form. I have been informed about the purpose of the COVID-19 diagnostic testing, procedures to be performed, potential risks and benefits, and associated costs. I have been provided an opportunity to ask questions before proceeding with a COVID-19 diagnostic test and I understand that if I do not wish to continue with the collection, testing, or analysis of a COVID 19 diagnostic test, I may decline to receive continued services. I have read the contents of this form in its entirety and voluntarily consent to undergo diagnostic testing for COVID-19.
>4. Financial Responsibility: I attest that I have provided the most accurate demographic and insurance information to the best of my knowledge. I understand that I generally won’t have any out-of-pocket costs if Covid-19 testing is covered by my insurance. I understand that if I live in California and are uninsured/underinsured I may apply for the Uninsured Program to cover the costs of my Covid-19 testing/treatment. I also understand if I am found to be not eligible for the uninsured program, if I provide inaccurate insurance information for billing, if insurance doesn’t cover COVID-19 services, or if the insurance sends me direct payment for my COVID-19 services, I may be billed for those services if correct information cannot be verified. I understand the information I give to request my test will be used to verify insurance eligibility.
5. OTC CONSENT:
By signing up with The Testing Co to receive COVID-19 tests on a monthly basis through this website at no cost to me, I consent to the following:
5.1. I consent to the use of my Protected Health Information (“PHI”) by The Testing Co LLC, for the purpose of submitting claims to my health insurance provider and such other purposes that are permitted under the federal Health Insurance Portability and Accountability Act (HIPAA) for reimbursement of COVID-19 tests ordered through this website.
5.2. I consent to The Testing Co submitting claims to my health insurance provider on a monthly basis until such time as I notify The Testing Co that I no longer wish to receive further COVID-19 tests, and I assign my right to receive any health insurance or other benefits in connection with the COVID-19 tests ordered through this website to The Testing Co in order to permit The Testing Co to submit such claims. I authorize payment directly to The Testing Co for such claims.
5.3. I consent to The Testing Co and/or my health insurance provider contacting me in connection with the COVID-19 tests ordered through this website, including via email, phone, or text message.
5.5. I agree that all of the above consents apply to any other persons covered by my health insurance policy on whose behalf I order COVID-19 tests through this website, including any minors, and I affirm that I have the authority to order COVID-19 tests on such persons’ behalf, including any minors.
5.6. I agree that, by ordering COVID-19 tests through this website or taking such tests, I am not entering into a doctor-patient relationship with The Testing Co or any entity or person affiliated with The Testing Co, and that any questions I may have concerning such tests, including but not limited to the results of such tests and any treatment, follow up, or other issues relating to such tests, are solely my responsibility. I also agree that I will report the result of each test ordered on the website, www.thetestingco.org.
5.8. I understand that the exact test that will be shipped by The Testing Co is based on availability. The COVID -19 test kits have been authorized by the FDA under an emergency use authorization.
5.9. I understand that while I may cancel at any time, only future orders of test kits may be canceled. I agree that any test kit that has already been ordered and has had a claim submitted to my insurance company may not be canceled.
5.10. The Testing Co’s terms and conditions may be changed at any time.
5.11. I attest that I have provided the most accurate demographic and insurance information to the best of my knowledge. I understand qualification to the program is verified through my insurance.
5.12. I understand that I won’t have to pay for the over-the-counter COVID-19 tests as long as my insurance provider covers this program. However, if I order more than the eight covered over-the-counter COVID-19 tests in any calendar month for myself, I may be responsible for the cost of additional tests that calendar month, unless I have additional health coverage. This means that The Testing Co., LLC/affiliates would ask you to pay for them. Note tests are sometimes packaged with more than one test per box, so eight tests may come in fewer than eight boxes.
5.13. I understand that if my insurance provider sends me a check for this program, I am required to submit this check/payment to The Testing Co., LLC/affiliates to cover the costs of my tests.
Forward checks to:
The Testing Co., LLC
512 N Larchmont Blvd
Los Angeles, CA 90004
5.14. The quantity limit of 8 tests per patient per calendar month applies only to the OTC COVID-19 tests and doesn’t apply for laboratory-performed COVID-19 tests and other COVID-19-related services.
COVID-19 NOTICE OF
The information The Testing Co. collects:
User-provided information: You may provide to The Testing Co. what is generally called “personally identifiable” information (such as your name, email address, postal mailing address, information relating to your medical practice, home/mobile telephone number, fax number, resume, or curriculum vitae) when using the Site. For example, if you use the Site/Location to contact/test with The Testing Co., you may provide your email address so that we can respond to you.
“Cookies” information: When you visit the Site, we may send one or more cookies – small text files containing a string of alphanumeric characters – to your computer. The Testing Co. may use both session cookies and persistent cookies. A session cookie disappears after you close your browser. A persistent cookie remains after you close your browser and may be used by your browser on subsequent visits to the Site. Persistent cookies can be removed. Please review your web browser “Help” file to learn the proper way to modify your cookie settings. Please note that disabling cookies may prevent you from accessing some of the functionality and site offerings available via the Site.
“Automatically collected” information: When you visit the Site, we may automatically record certain information from your web browser by using different types of technology, including “clear GIFs” or “web beacons.” This “automatically collected” information may include Internet Protocol address, web browser type, the web pages or sites that you visit just before or just after the Site, the pages you view on the Site, to device used (tablet, mobile, desktop), referral URLs, and the dates and times that you visit the Site. The information collected is not associated with your name or other information you voluntarily provide.
Protected Health Information (PHI): When receiving orders for testing, generating test results and transmitting information to a healthcare provider, The Testing Co. is subject to laws and regulations including the Health Insurance Portability and Accountability Act of 1996 (HIPAA). PHI will only be used or disclosed as authorized in The Testing Co. Notice of Privacy Practices.
The way we use information:
to operate, maintain, enhance, and provide all of the features and information found on the Site/Location.
for administrative purposes, for customer service purposes, and to understand and analyze the usage trends and preferences of our Users. This Website uses Google Analytics which is a service related to website activity and internet usage.
to understand and improve the way the Site works and looks, and to create new features and functionality.
to: (a) remember your information so that you will not have to re-enter it during your visit or the next time you visit the Site; and (b) monitor aggregate site usage metrics such as total number of visitors and pages viewed.
to deliver promotional messages or materials that may be of interest to you and otherwise tailor our interactions.
to respond to your inquiries or send requested information about our products and services.
to detect, prevent and address intellectual property infringement, rights of privacy, or defamation issues or other misuses of the Site.
We only collect personal data we need to perform our healthcare services and obtain the minimum necessary for our business purposes.
We collect and process personal information when setting up and testing the individual, which includes for the User (person being tested), first name, last name, gender, ethnicity, email address, full address, phone number, date of birth, Insurance (if applicable for billing) and the results of the COVID-19 test. This information will be made available to individuals authorized by The Testing Co. or the Business User (entity or organization that will be communicating/receiving from The Testing Co. the COVID-19 test results) for purposes of reviewing test results and providing notification of the results. If you contact The Testing Co’s customer services personnel, we will keep a separate record relating to your request for technical support.
We use personal information to: (1) provide the User(Individual), Business User, and Testing User with access to these results; and (2) comply with legal obligations, including those related to safety, quality and improvement (3) bill for provided testing services.
We strictly limit who we share personal information with and will not sell the personal information to third parties for our commercial benefit.
Under what circumstances we disclose information:
We may use the information we collect for various purposes including but not limited to:
provide automatically collected and other aggregate non-personally-identifiable information with interested third parties to assist such parties in understanding the usage, viewing, and demographic patterns for certain programs, content, services, advertisements, promotions, and/or functionality on the Site.
in conducting market research including survey and analysis
in working with some authorized service providers to provide website hosting and maintenance as well as other services for us. To the extent it is necessary for these service providers to complete their contractual obligations to The Testing Co.
to business partners that deliver advertisements, promotional materials of other marketing communications ( some may automatically collect information about your online activity over time to help target advertisements on this and other sites and platforms. We do not share your personally identifiable information with other organizations for their marketing or promotional uses.
in complying with the law or in the good-faith belief that such action is necessary to comply with state and federal laws or respond to a court order, judicial or other government subpoena, or warrant. In some cases, we may make such disclosures without first providing notice to Users.
we also reserve the right to disclose User information that we believe, in good faith, is appropriate or necessary to take precautions against liability; protect The Testing Co. from fraudulent, abusive, or unlawful uses; to investigate and defend ourselves against any third-party claims or allegations; to assist government enforcement agencies; to protect the security or integrity of the Site; or to protect the rights, property, or personal safety of The Testing Co., our Users, or others.
we may share reports on demographics or traffic patterns from de-identified information with third parties.
We may share information with your healthcare provider(s).
We may hire service providers such as a billing vendor and The Testing Co. will give these service providers only that information which they require to fulfil their function. We require our service providers contractually to maintain confidentiality of the information they receive.
We do not share, trade, rent or sell your personally identifiable information with other organizations for their marketing or promotional uses without your permission . You may decline to share your personally identifiable information with The Testing Co. or request deletion of your personally identifiable information. If you wish to stop receiving personalized information or marketing communications from us or want to opt-out of our sharing your personal information collected through this Site with our business partners for marketing purposes, please submit a request. Our contact information is listed in the “Contact us” section below.
Our commitment to children’s privacy:
Protecting the privacy of young children is especially important. For that reason, The Testing Co. does not knowingly collect or maintain personally identifiable information on Site from persons under 13 years of age, and no part of the Site is directed to persons under 13. If The Testing Co. learns that personally identifiable information of persons less than 13 years of age has been collected by The Testing Co., then The Testing Co. will take the appropriate steps to delete this information.
Our commitment to data security:
We use commercially reasonable physical, managerial, and technical safeguards to preserve the integrity and security of your personal information. We cannot, however, ensure or warrant the security of any information you transmit to us, and you do so at your own risk. Once we receive your transmission of information, The Testing Co. makes commercially reasonable efforts to ensure the security of our systems. However, please note that this is not a guarantee that such information may not be accessed, disclosed, altered, or destroyed by breach of any of our physical, technical, or managerial safeguards.
By providing personal information or using the Site/Location you agree for us to communicate with you electronically regarding test results, issues of security, privacy, or administrative issues as they relate to the use of the Site/Location.
Personally identifiable information collected on the Site may be stored and processed in the United States, and by using the Site you consent to any such transfer of information outside of your country.
In the event of merger or sale:
In the event that The Testing Co. is acquired by or merged with a third-party entity, we reserve the right, in any of these circumstances, to transfer or assign the information that we have collected from Users as part of such merger, acquisition, sale, or other change of control without prior notice to you.
Contact us or update your preferences: