CONFIDENTIAL HUMAN IMMUNODEFICIENCY VIRUS (HIV) TEST
Non-Health Care Settings
No person shall perform an HIV test in a non-healthcare setting without first obtaining the informed consent of the test subject or his or her legal representative. Written informed consent must be obtained as required by Rule 64D-2.004(3), of the Florida Administrative Code. Exceptions to obtaining informed consent can be found in Section 381.004(2)(h), Florida Statutes. This form may be used to document the test subject’s informed consent or to satisfy the requirement that such consent be in writing. HIV test results and the fact that a person is tested are confidential and protected by law. Persons with knowledge of an individual’s HIV test result have legal obligations to protect this information from unauthorized disclosure. Florida law imposes strict penalties for breaches of confidentiality.
HIV testing is a process that uses FDA-approved tests to detect the presence of HIV, the virus that causes AIDS and to see how HIV is affecting your body. One of several types of tests may be offered to you. The most common type of HIV test detects antibodies produced by the body after HIV infection. Test results are highly reliable, but a negative test does not guarantee that you are healthy, Generally, it can take up to three months for HIV antibodies to develop. This is called the “window period.” During this time, you can test negative for HIV even though the virus is in your body and you can give it to others. A positive antibody HIV test means that you are infected with HIV and can also give it to others, even when you feel healthy. Other tests can detect the presence of virus in your blood, measure the amount of virus in your blood, measure the number of T-cells in your blood, or see if the virus is susceptible to HIV/AIDS medications. Some of these tests may require a second specimen to be obtained for further testing. Generally, test results will be available in about two weeks.
If you consent by filling out and signing this form, a specimen will be taken and you will be tested.
If a rapid HIV test is used, results will be available the same day. If the rapid test detects HIV antibodies, it is very likely that you are infected with the virus, but this result will need to be confirmed. You will be asked to submit a second specimen for further testing. The results from this confirmatory test will be available to you in about two weeks.
If you test positive, the local health department will contact you to help with counseling, treatment, and other supportive services if you need and want them. You will be asked about sex and/or needle-sharing partners, and voluntary partner services (PS) will be offered to you. The HIV test result will become part of your confidential medical record. If you are pregnant, or become pregnant, the test results will become part of your baby’s medical record.
Finding HIV infection early can be important to your treatment, which along with proper precautions, helps prevent spread of the disease.
If you are pregnant, there is treatment available to help prevent your baby from getting HIV.
COMMUNITY RIGHTFUL CENTER
PATIENT CONSENT FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
With my consent, COMMUNITY RIGHTFUL CENTER of Miami-Dade (CRC), may use and disclose protected health information about me to carry out treatment, payment and healthcare operations (TPO). Please refer to (CRC) Notice of Privacy Practices for a more complete description of such uses and disclosures.
I have the right to review the Notice of Privacy Practices prior to signing this consent.
CRC reserves the right to revise its Notice of Privacy Practices at any time. A revised notice of Privacy Practices may be obtained by forwarding a written request to the Privacy officer at CRC, 9526 NE 2’* Ave, Miami Shores, FL 33138 – Phone : (305) 754-5701.
With my consent, CRC may mail to my home or other designated location and leave a message on a voicemail or in person in reference to any items that assist the practice in carrying out the TPO, such as appointment reminders, insurance items and calls pertaining to my clinical care.
With my consent, CRC may mail to my home or other designated location any items that assist the practice in carrying out the TPO, such as appointment reminders, and patient statements as long as they are marked “Personal and Confidential”.
With my consent, CRC may e-mail to my home or other designated location any items that assist the practice in carrying out the TPO, such as appointment reminders, and patient statements. I have the right to request that CRC restrict how it uses or discloses my PHI to carry out TPO. However, the practice is not required to agree to my requested restrictions, but if it does, it is bound by this agreement.
By signing this form, I am consenting to CRC use and disclosure of my PHI to carry out TPO.
I may revoke my consent in writing except to the consent that the practice has already made disclosures in reliance upon my prior consent. If I do not sign this consent, CRC may decline to provide treatment to me.