TERMS & CONDITIONS / TERMINOS Y CONDICIONS

Personal Information Privacy and Use of Results:

TYDUSGROUP will not receive your individual named sample or results from this test and will not retain any right to test your sample for any purpose other than determining if you have antigen / antibodies directed against SARS-CoV-2 (and FLU A & B if selected). Under no circumstance will any personal information be made available to, or disclosed by, TYDUS GROUP, with the exception of this Consent Form. 

Assumption of Risk and Release:

I recognize that there are certain inherent risks associated with having my sample analyzed. I hereby consent for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily agree to have my sample analyzed by the AssureTech Ecotest Covid-19 IgG/IgM Rapid Detection Test / BD Veritor System for Rapid Detection of SARS-CoV-2 Analyzer / CareStart Covid 19 Rapid Antigen Test / BD Veritor System for Rapid Detection of FLU A & B TEST and hereby waive any and all rights, claims, or causes of action of any kind whatsoever arising out of my participation in this activity, and do hereby release and forever discharge TYDUS GROUP, its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors, and assigns for any physical or psychological injury, including but not limited to illness, paralysis, death, economical or emotional loss, that I may suffer as a direct result of my participation in this activity, including traveling to and from any location related to this activity. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

Indemnification:

I agree to indemnify and hold harmless TYDUS GROUP against any and all claims, suits, or actions of any kind whatsoever for liability, damages, compensation, or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If TYDUS GROUP incurs any of these types of expenses, I agree to reimburse TYDUS GROUP for these expenses.

Guidance:

I understand that the FDA has allowed the use of the AssureTech Ecotest Covid-19 IgG/IgM Rapid Detection Test / BD Veritor System for Rapid Detection of SARS-CoV-2 Analyzer / CareStart Covid 19 Rapid Antigen Test even though it has not yet been formally approved. According to FDA Guidance, we are required to inform you of the following: (1) This test has not been reviewed by the FDA. (2) Negative results do not rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic should be considered to rule out infection in these individuals. (3) Results from antigen / antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection or to inform infection status. (4) Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E. (5) This test is not for the screening of donated blood
NEXT
Signature    

TEST SCREENING WAIVER / EXENCION DE PANTALLA DE PRUEBA

This consent provides TYDUS GROUP, and its subsidiaries (“BRIGHTSIDE SPECIALTY PHARMACY”) with your permission to perform a COVID-19 tests (and FLU A & B if selected) based on TYDUS GROUP’s policies and procedures. 

By signing below, you are indicating that you voluntarily consent to this procedure for the detection of COVID-19 antigen and antibodies (and FLU A & B if selected).

The antigen test being administered involves a nasal swab to obtain a sample which will then be tested for the presence of antigen that may indicate the presence of COVID-19 (and FLU A & B if selected). You will be required to stay in a designated area pending results of the test, and based on the results, you may not be allowed to enter the pharmacy.

The antibody test being administered involves a finger-prick to obtain a small blood sample which will then be tested for the presence of antibodies that may indicate the previous presence of COVID-19. You will be required to stay in a designated area pending results of the test, and based on the results, you may not be allowed to enter the pharmacy.

The COVID-19 antigen / antibody test has been allowed for use by the Food and Drug Administration (“FDA”) but has not been approved by the FDA. This test alone may not be sufficient to detect or rule out the possibility that you have been exposed to or are infected with COVID-19. You should carefully monitor your own symptoms and, notwithstanding the results of any testing, you must stay home and consult with your physician if you experience symptoms of COVID-19.

You have the right to discuss the proposed testing with your physician, to learn about the purpose, potential risks and benefits of any testing.

By signing below, you consent to the disclosure of such information as requested, recommended or required by federal, state, and local public health authorities.

Personal Information Privacy and Use of Results. TYDUS GROUP will not receive your individual named sample or results from this test and will not retain any right to test your sample for any purpose other than determining if you have antigens / antibodies directed against SARS-CoV-2 (and FLU A & B if selected). Under no circumstance will any personal information be made available to, or disclosed by, TYDUS GROUP, with the exception of this Consent Form.

By signing below, you agree to release and waive any claim arising from your selection to receive this screening, that may arise against TYDUS GROUP and its designated medical providers and staff members. In addition, by signing below, you acknowledge that any testing that may be performed for COVID-19 antigens / antibodies has not been approved by the Food and Drug Administration (FDA). Accordingly, you agree to release and waive any claim that might arise against TYDUS GROUP and its designated medical providers and staff members for any risks, side effects, or complications resulting from the testing.
NEXT
Signature