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COVID testing form-Medicare, Medicaid, Self-pay

    I hereby grant permission to Arundel Pharmacy to perform certain screening tests as set forth below at my direction, which may include by nasal, nasopharangeal or oropharangeal swab or blood by venipuncture or finger stick. I authorize Arundel Pharmacy to obtain these screening results and provide them to me via phone, email or both. I agree to pay for the tests in full at time of service. I understand testing has not been ordered by a physician and is done for my own use and not for medical diagnostic or treatment purposes. Because tests are not ordered by a physician , insurance coverage may not be available. I understand these tests have not cleared or approved by the FDA and all these tests have been authorized by FDA under EUA’s for use by authorized laboratories. I HEREBY CERTIFY THAT I HAVE READ THE ABOVE ACKNOWLEDGEMENT AND HAVE HAD AN OPPURTUNITY TO ASK QUESTIONS. BY SIGNING BELOW, I CONSENT TO UNDERGO THE SELF-DIRECTED LABORATORY TESTING UNDER THE CONDITION SET FORTH HEREIN.