Health Screening Services, LLC

Consent for Services

Last Modified: December 2020

NOTICE OF PRIVACY PRACTICES

We are required by law to maintain the privacy and security of your protected health information.  We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.  We must follow the duties and privacy practices described in this notice and give you a copy of it.  We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

CHANGES TO THE TERMS OF THIS NOTICE

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

This Notice of Privacy Practices applies to Health Screening Services, LLC dba "Health Screening Solutions", dba "EasyTesting" sometimes referred to as "Easytesting.com" and made effective on September 1, 2020.

USER'S RIGHTS

• You can ask to see or get an electronic or paper copy of your record and other information we have about you. We will provide a copy or a summary of your record within 30 days of your request. We may charge a reasonable, cost-based fee for this service.

• You can ask us to correct relevant information related to your record. We may decline to make an update but we’ll outline a reason for our decision in writing within 90 days.

• You can request a preferred means of communication.

• While we are not required to agree to your request, you may also ask us not to use or share certain health information for treatment, payment, or our operations.

• If you pay for a service out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer unless the law prohibits us from doing so.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

• You can ask for a paper copy of this notice at any time.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices on your behalf.

• If you feel we have violated your rights in any way, you have the opportunity and right to contact us at info@healthscreeningsolutions.com.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

You have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care

• Share information in a disaster relief situation

• Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

HOW INFORMATION IS SHARED

We can use your health information and share it with other professionals who are treating you.

We can use and share your health information to run our practice, improve your care, and contact you when necessary. We are allowed or required to share your information in other ways —usually in ways that contribute to the public good, such as public health and research. We train all employees and adhere to all areas of the law when sharing information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

We can share health information about you for certain situations such as:

• Preventing disease

• Helping with product recalls

• Reporting adverse reactions to medications

• Preventing or reducing a serious threat to anyone’s health or safety

We can use or share your information for health research.

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

We can share health information about you with organ procurement organizations.
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

We can use or share health information about you:

• For workers’ compensation claims

• For law enforcement purposes or with a law enforcement official

• With health oversight agencies for activities authorized by law

• For special government functions such as military, national security, and presidential protective service

In these cases we never share your information:

• Marketing purposes

• Sale of your information

• Most sharing of psychotherapy notes.

Introduction

This consent form (“Consent”) reviews the benefits, risks and limitations of you (referred to as “you” or “your”), as the person who is utilizing the Services provided by Health Screening Services, LLC. (referred to as “HSS” “Easy Testing”, “we”, “us” or “our”). It also explains how your information and sample(s) will be used after performance of the Services. Your sample(s) will not be processed unless you confirm that you have read and understood the contents of this form.

By using our Site or Services and/or agreeing to this Consent, you indicate that this Consent is a binding agreement and that you have read and understood the following terms. Capitalized terms used but not defined in this Consent have the meaning given to them in our other policies.

By clicking your acceptance, you have chosen to use our Services and have given your informed consent to have your biological sample(s) collected and/or tested for biomarkers and/or genes.  Depending on the test purchased, biological samples shall consist solely of human fluids and/or tissue samples that are intended to be analyzed for your use and to inform you about your test results. 

By clicking your acceptance, you have also agreed to allow the Lab to deliver your results directly to Easy Testing. If you have been provided this test by or on behalf of your university, workplace, employer, or other organization (collectively, "Test Provider") of which you are a member or working with or for, you additionally consent to having your information shared with such Test Provider and the Test Provider's contractors and representatives directly or indirectly. That information will include but is not limited to test results and contact information.

Voluntary Participation

Our Services are offered and available to users who are 18 years of age or older and are residents of the United States. Your use of our Services is voluntary. It is your choice whether to utilize our Services or not. Prior to signing this Consent, you may wish to speak with your healthcare provider or others for further guidance about our Services.

Procedures and Protocol for HSS Tests

When you order a test or make a reservation, we will collect some information from you. We cannot perform the Services without collecting information from you but we will only collect information that will assist us in providing the Services that you have requested. In order for the Services to be provided as intended, you must provide accurate and correct information. Failure to provide required information or to execute required documents may result in your sample(s) not being tested.

After completing your reservation, you will show up at the appropriate testing location and at the reservation time to have samples collected (i.e., blood, saliva, urine, etc.).  The test kit and materials will be provided at the testing location, administered by a healthcare professional, and sent to one of our designated testing laboratory partners (“Lab”) to be processed. 

The results of your test(s) will be made communicated to you directly by the Lab.  In the event we determine that a biological sample is not suitable for testing due to the content of the sample or because we believe the sample to have been submitted in violation of this Consent or our other terms, conditions and policies, we reserve the right to withhold the results and to not provide a refund. 

Risks

In order to utilize our Services, the appropriate biological sample(s) must be collected for the test(s). There are no risks associated with using the containers provided in the test kit(s). If you have a history of issues with certain tests, we advise avoiding such tests.

Disclosing certain information may make you uncomfortable. Our Services include testing you for viruses that may result in positive findings.  This information may be distressing.

Information that you choose to share with your physician or other healthcare providers may become part of your medical record and through that route may be accessible to other healthcare providers and/or insurance companies in the future.  Information that you share with family, friends or employees may also be used against your interests.  Even if you share information that has no or limited meaning today, that information could have greater meaning in the future as new discovered are made.

The Lab, or the Health Consultant who reviews your results, may advise you to have a follow-up visit with your doctor after reviewing the results of your test. As a result, you may learn about health conditions and problems or potential health risks that you were not aware of before you utilized our Services. You may experience stress, anxiety, or emotional or physical discomfort when you learn about your test results, health problems or potential health problems. There may also be additional risks of utilizing our Services that are currently unforeseeable.

Limitations

OUR SERVICES DO NOT PROVIDE MEDICAL ADVICE. The information and content provided, including but not limited to text, graphics, images, videos, and other materials contained in the Services, are for informational purposes only and are not intended as a substitute for professional medical advice, help, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding your tests results and medical care, and never disregard professional medical advice or delay seeking it because of something you have read on or via our Site. Nothing contained in the Services is intended to constitute a medical diagnosis or treatment. Reliance on any information appearing in the Services, including but not limited to information provided by HSS or by other users of the Services, is solely at your own risk. By clicking your acceptance, you understand and agree that your results are not intended to be used for any diagnostic purposes and are not a substitute for professional medical advice. You understand that our Services are for information and educational use only; HSS does not provide medical services, diagnosis, prognosis, treatment, or advice.

HSS does not warrant the accuracy, completeness, timeliness or usefulness of the test results or any opinions, content, services or other information provided through the Services or on the Internet generally. HSS and its affiliates, licensors, and suppliers have no control over and accept no responsibility for your compliance with the laws applicable to you and your state of residence.

HSS implements several safeguards to avoid technical errors, but as with all medical and diagnostic tests, there is a chance of a false positive or a false negative result. A false positive result means that the COVID-19 virus or indicators of the COVID-19 virus infection or prevalence were detected, which is not in fact present. A false negative result means the test failed to identify that the COVID-19 virus or indicators of the COVID-19 virus infection or prevalence were in fact present. Other sources of error include sample mix-up, poor sample quality or contamination, and technical errors in the Lab. Some biological factors may limit the accuracy of the results or prevent the Services from being completed.

Testing result interpretation is based on currently available information in the medical literature and scientific databases. The field of testing is constantly changing and our understanding of the available technologies and resources is evolving. New information may replace or add to the information that we used to interpret your results. We are not obligated to notify you if there is a new understanding that might result in a change to the interpretation of your results. We reserve the right to contact you, at our option, in the future.

Retention and Use of Your Information

We are subject to multiple laws on the retention of data. Accordingly, we retain any information collected about you for as long as we are required to maintain it for regulatory and compliance purposes or for a legal or business necessity.

Sample(s) will be sent directly to the Lab that will conduct the test. HSS has no obligations or liability regarding the retention of your sample(s). You understand that by providing any sample, having your sample processed, accessing your results, or providing information to us, you acquire no rights in any research or commercial products that may be developed by HSS, the Lab or any collaborating partners or contractors. You specifically understand that you will not receive compensation for any research or commercial products that include or result from your sample or information.

Your information and test results may be stored in a repository and used for validation, educational, and/or research purposes. By clicking your acceptance of this Consent, you acknowledge and agree that HSS may de-identify the information that is obtained from our Services and that we may aggregate this information with additional de-identified information from other users and tested persons. De-identification means that the personally identifiable information associated with your information will be removed. (1) You understand that we would not disclose, sell and otherwise commercialize your identifiable information, but (2) You understand that we may disclose, sell and otherwise commercialize de-identified information / User Content without restriction.

We may incorporate different or additional technologies to test or analyze data in the future. We may, at our sole discretion, choose to test or analyze your data using such technologies. We are not obligated to notify you if we chose to conduct different or additional testing or analysis on your data. Your purchase and/or use of our Services and/or products does not automatically include any such different or additional technologies. You may have to pay additional fees in order to receive Services using any future or additional technologies or features.

Confidentiality

By clicking your acceptance of this Consent, you acknowledge that you have read and understand our Privacy Policy and HIPAA Privacy Authorization. You agree the HSS is not liable for the unauthorized release of your results or information unless such unauthorized release was the result of gross negligence or willful misconduct on the part of HSS.

Withdrawal of Consent

Your use of our Services is voluntary. You may choose to withdraw your Consent or to stop using our Services at any time. Such requests to should be sent to us by email at info@healthscreeningsolutions.com  or in writing at Health Screening Services, 924 Valmont St., Ste 300, New Orleans, LA 70115.

Please note that while any changes you make will be reflected in our databases within a reasonable period of time, we may retain your information in the ordinary course of business, for the satisfaction of our legal obligations, or where we otherwise reasonably believe that we have a legitimate reason to do so. Information that has already been de-identified, anonymized, or aggregated may not be retrievable or traced back for destruction, deletion, or amendment.

Legal Agreement

You give permission for HSS, the Lab, and our and their representatives, contractors, affiliates, staff, agents, and designees to perform the requested Services on the sample(s) you provide and to disclose your information and results in accordance with our Privacy Policy and your HIPAA Privacy Authorization. You are not an insurance company or an employer attempting to obtain information about an insured person or an employee.

Special Notice for COVID-19 Testing In Connection with Employment for Work Safety Purposes

If COVID-19 testing is being provided by your employer or other Test Provider in connection with or for work safety testing purposes on either a voluntary or mandatory basis, then the following additional statements apply and supersede other provisions in this form. Your signature on this Consent for Services form means you have read, understood and agree to the following:

This COVID-19 testing is for public health and work safety purposes, is not a health benefit and is not part of a health plan or wellness plan. You are an employee or contractor undergoing testing in connection with your employment or work.

Results from the COVID-19 testing, as well as information you provide during registration, will be shared by HSS and the Labs with your employer or other Test Provider plus the vendor who provides services to your employer or other Test Provider  in support of the employer’s or other Test Provider's business related to these results, including your employer’s or other Test Provider's affiliates. Signing this Consent for Services form is required in order to receive these COVID-19 testing services.

Although this form may mention other tests provided by HSS, the specimen you provide will ONLY be tested to diagnose COVID-19. Wording regarding ANY other types of tests or testing does not apply and should be disregarded. 

This COVID-19 testing, if being provided by your employer or other Test Provider, may be provided at no cost to you, in which case wording about fees, insurance, refunds, and reimbursement do not apply and should be disregarded.

Any resulting research studies, publications or commercial uses conducted by or for HSS or the Labs will not identify you, your employer, other Test Provider, your employer’s or other Test Provider's affiliates.

You can opt out of receiving marketing communications from HSS through “unsubscribe” links available on all marketing communication.

This COVID-19 testing does not involve medication or treatment for COVID-19. Physician consultation provided as part of this COVID-19 testing are physician services necessary to perform the COVID-19 testing, such as education to you regarding the test result and a telehealth consult. These services do not involve medication or treatment. As with other types of lab testing, there may be false positives and false negatives. If you have a positive test result, you should follow up with your personal health care provider.

This COVID-19 test is a point in time snapshot about your current status at this time; a person could still contract COVID-19 or test positive for COVID 19 in the future even if he/she has a negative result now.

Contacting HSS

If you have questions or comments about our Services or this Consent, please contact us by email at info@healthscreeningsolutions.com or in writing at Health Screening Services, LLC, 924 Valmont St., Ste 300, New Orleans, LA 70115.