I understand that I am voluntarily requesting and consenting to be tested for Human Immunodeficiency Virus (HIV).
I acknowledge that this test is being performed for my personal
health information, diagnosis, and/or screening purposes.
I understand that:
• HIV testing is voluntary, and I may refuse testing at any time.
• The test may involve a blood draw or other approved specimen collection method.
• Results may be positive, negative, or indeterminate, and additional testing may be required for
confirmation.
• A negative result does not guarantee that I am free from HIV infection if exposure was recent
(window period).
• A positive result will be communicated to me confidentially, along with counseling and referral for
medical care and treatment options.
• My results will be kept confidential in accordance with applicable privacy laws and regulations.
I understand that my information and test results will be handled in a discreet and confidential
manner and will only be shared with authorized healthcare personnel involved in my care, unless I
provide written permission otherwise or disclosure is required by law.
I have had the opportunity to ask questions about HIV testing, and all of my questions have been
answered to my satisfaction. I understand the purpose, benefits, and limitations of the test.
