Informed consent to perform HIV testing

BEFORE YOU TEST, PLEASE REVIEW THE FOLLOWING INFORMATION

Your authorizing physician has given you the following information on HIV Testing:

  1. I am giving my permission for a blood test in order to detect whether I have antibodies to the HIV virus (Human Immunodeficiency Virus) or any other identified causative agent of AIDS in my blood. I understand that the test results will be used for the purposes of my medical care and treatment.
  2. I understand that the test is performed by withdrawing a sample of my blood and conducting laboratory tests to determine the presence of antibodies to HIV. I understand that the results of the blood tests considered to be positive will be reported to the state department of health.
  3. I further understand that a positive result does not mean I have AIDS, but that my blood has been exposed to the AIDS virus and antibodies to that virus are present in my blood. I understand that counseling concerning AIDS will be offered to me if my test results are found to be positive.
  4. I understand there are a number of treatment options available. These options have greatly improved the quality of life for people living successfully with HIV and would be discussed with the physician or other health care provider.
  5. I understand that individuals with HIV/AIDS can adopt safer practices to protect uninfected persons from acquiring HIV.
  6. I have been informed and understand that test results, in a percentage of cases, may indicate that a person has antibodies to the virus when the person does not have the antibodies (a false positive result) or that the test may fail to detect that a person has antibodies to the virus when the person does in fact have these antibodies (a false negative result).
  7. I understand that even with a negative result, it is important to continue to be routinely tested.
  8. I understand that my test results will be released to my physicians and other health care providers providing my care. I understand that my test results will be kept confidential to the extent provided by law. In addition, I understand that I may withdraw from the testing at any time, prior to the completion of laboratory tests.
  9. I have been advised about the purpose, potential uses, limitations and meaning of the test results; the voluntary nature of the test; the right to withdraw at any time, prior to the completion of laboratory tests; and the confidentiality protections under the law.
  10. I understand that the law prohibits discrimination based on an individual's HIV status and services are available to help with such consequences.
  11. I understand that I can call 866-660-2593 to ask any questions about this informed consent. With the information presented above having been completely and clearly explained to me and all of my questions having been answered, I hereby authorize Analyte to arrange for me to be tested for HIV infection.