In consideration for receiving the opportunity to participate in COVID-19 testing, which is provided by The Radiance Diagnostics, I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes company and their healthcare staff, members, shareholders, officers, servants, agents, volunteers, or employees (herein referred to as “indemnities”) from any and all liabilities, claims, demands, injuries, (including death), or damages, including court costs and attorney’s fees and expenses, that may be sustained by me while participating in testing while traveling to and from the testing, or while on the premises own or leased by indemnitees.
I am fully aware that the testing provided by Company may involve COVID-19 tests that have not gone through a full FDA approval process and instead obtained emergency use authorization (EUA) or registered or are pending such processing and the results could produce false positives or negatives, or by administrated in a way that otherwise produces inaccurate results. I am also aware the Company is not providing medical care or medical diagnosis with Testing and that I should consult my doctor or go to an emergency room if I have serious symptoms and/or to obtain medical advice from my own doctor as to the results of Testing.
I hereby waive my rights regarding protected health information under HIPAA, to the extent necessary to complete the Testing and to allow the Company to provide the results (whether positive or negative) of Testing to (1) the organization which has arranged for the testing, and (2) local and state public health authorities (which may result in further direct communication from those entities to me for further follow-up and contact tracing). Protected health information will not be reused or disclosed by Company to any person or entity other than above, except as required by law.
By signing below, I am agreeing to voluntarily test. In signing this agreement, I acknowledge and represent that I have to read it, understand it, and sign it voluntarily.