Covid19 – Graceful In Home

The following has been explained to me, and I agree:

I will have a rapid Covid-19 test performed at Graceful In Home Healthcare.

A positive test is considered diagnostic, and a confirmatory testing will be needed and a referral will be made to a third-party lab.

In cases where symptoms are strongly suggestive of Covid-19, a confirmatory test referral will be made to a third-party testing of patient choice.

In case I don’t get notified within 72 hrs., I will call Graceful In Home Healthcare at 402-387-7933 for my test result.

By law, the Nebraska Department of Health and human Services DHHS will be notified that I was tested, and what the test results are.

In addition, I have been shown a copy of the instructions of what I have to do following testing, I have read those discharge instructions thoroughly, and I Agree to comply with those instructions. I agree to self-quarantine until I am cleared.

I acknowledge and understand that my COVID-19 diagnostic test will require the collection of an appropriate sample by my healthcare provider through a nasopharyngeal swab, as the recommended collection procedures.

I understand that there are risks and benefits associated with undergoing a diagnostic test for COVID-19 and as with any medical test, there may be a potential for false positive or false negative test results.

I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have question or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider.

***I understand that Rapid COVID-19 testing is available for cash/card pay only and my insurance will NOT be billed for Rapid COVID test.

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