Please carefully read and sign the following Informed Consent:

I. I authorize this COVID-19 testing unit to conduct collection and testing for COVID-19 through a
nasopharyngeal swab or blood draw, as ordered by authorized medical personnel at Middle River
Healthcare or provider.

II. I authorize my test results to be disclosed to the county, state, or to any other Governmental
entity as may be required by law.

III. I acknowledge that a positive test result is an indication that I must self-isolate and/or wear a mask or face
covering as directed to avoid infecting others.

IV. I understand the testing facility/unit may not be acting as my medical provider, this testing 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 condition worsens.

V. I understand that, as with any medical test, there is the potential for a false positive or false negative
COVID-19 test result.

I, the undersigned, have been informed about the test purpose, procedures, possible.

benefits and risks. I have been given the opportunity to ask questions before I signed, and I have been told that I can ask
additional questions at any time. I voluntarily agree to this testing for COVID-19.

I acknowledged that by submitting this form I have been informed about the test purpose, procedures, possible. benefits and risks. I have been given the opportunity to ask questions before I signed, and I have been told that I can ask additional questions at any time. I voluntarily agree to this testing for COVID-19.