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322-3506 or 512-322-3552 fax www.tdi.state.tx.us Insurer Address NOTICE AND CONSENT FOR HIV-RELATED TESTING To evaluate your insurability, the Insurer named above (the Insurer) has requested that you provide a sample of your blood, oral fluid extracted from cheek and gum tissue, or urine for testing and analysis to determine the presence of human immunodeficiency virus (.

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I understand that I can withdraw my consent for future tests at any time. If I test positive for HIV infection, I understand that my health care provider will talk with me about telling my sex or needle-sharing partners of possible exposure. I may revoke my consent orally or in writing at any time.

Lab No: Date: Name: Age: Sex: Address: Tel.: Mobile: Consent: I, the undersigned agree to get my blood tested for HIV Antibodies and provide my identification proof *. The significance and relevant information of this test (Pre Test Counseling) have been provided to me.

The NYSDOH Form 2557 Authorization for Release of Medical Information and Confidential HIV Related Information, is used for this purpose. This form allows for the release of both HIV-related information and non-HIV-related information.

Informed consent for testing means that the person being tested understands HIV testing procedures, the reasons for testing and is able to assess the personal implications of testing before deciding whether to be tested.

Informed consent for hiv testing the features which precipitate testing such as clinical presentation, risk exposure, epidemiology and prevalence and patient initiation; an assessment of the person being tested with respect to their understanding of the HIV testing process and consequences of the result, and.

I have been given the opportunity to ask questions concerning the test for HIV antibodies, and I acknowledge that my questions have been answered to my satisfaction. By my signature below, I consent to be tested for HIV.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232