COVID-19 TESTING CONSENT
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By submitting this form, you are consenting for COVID-19 testing. If you or the patient feels ill, you should seek medical attention as soon as possible. You consent that the information on this form is accurate and agree to receive results via email or text. I understand this test does not confirm a medical evaluation. You authorize JL Hudson Holdings LLC or its assignee to bill your insurance/health coverage for these services; when available. You authorize us to release any information/medical records for billing and reimbursement to state/county authorities as required by state guidelines. If your insurance company pays you directly for our services, you agree to endorse that payment to us within 15 days of receipt. This screening is free. There is no out-of-pocket expense to your family. All tests will be charged through insurance. If your insurance company sends you a notice that they are denying coverage, do not be concerned, as JL Hudson will waive their fee with no additional action required from you. If you do not have insurance, JL Hudson will waive the fee.