The above named person was tested with nasopharyngeal swab using the BD Veritor Plus
Analyzer. The sample was collected by an approved licensed practitioner.
Please carefully read and sign the following informed consent:
1.I authorize this COVID-19 testing unit to conduct collection and testing for COVID-19 through a nasopharyngeal swab,
as ordered by an authorized medical provider or public health official.
2. I authorize my test results to be disclosed to the county, state, or to any other governmental entity as may be
required by law.
3.I acknowledge that a positive test result is an indication that I must continue to self-isolate in an effort to avoid
4.I understand the testing unit is not acting as my medical provider, this does not replace treatment by my medical
provider, and I assume complete and full responsibility to take appropriate action with regards to 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
5.I understand that, as with any medical test, there is the potential for false positive or false negative test results can
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. I have been given the opportunity to ask questions before I sign, and I have
been told that I can ask other questions at any time. I voluntarily agree to testing for COVID-19.
The local health jurisdiction has determined that if you are under suspicion for having COVID-19 due to symptoms and
testing request, that it is necessary to be placed in isolation in order to prevent the transmission of this infection. It is
important for you to comply with this Isolation Agreement in order to protect the public’s health. Thank you for agreeing