PWNHEALTH WILL NOT PROVIDE ANY SERVICES FOR MEDICAL EMERGENCIES OR URGENT SITUATIONS. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL YOUR DOCTOR OR 911 IMMEDIATELY.
YOU SHOULD CONTACT YOUR HEALTHCARE PROVIDER IF YOUR SYMPTOMS GET WORSE OR YOU EXPERIENCE ANY NEW SYMPTOMS.
Your use of the PWNHealth Services is subject to our Notice of Privacy Practices, our Informed Consent, any additional consents that you provide and any additional terms or policies of which we provide notice to you.
By using the PWNHealth Services, you acknowledge that you have read, understood and agree to be legally bound by and comply with these Terms, the Notice of Privacy Practices, the Informed Consent and any and all additional terms and policies. IF YOU DO NOT AGREE WITH THESE TERMS, DO NOT USE THE PWNHEALTH SERVICES.
- Changes to our Terms.
We reserve the right to modify or amend these Terms, in whole or in part, at any time, and for any reason, in our sole discretion, with or without liability to you or any third party. All changes to these Terms will be effective immediately upon their posting to this webpage. We will notify you of material changes to these Terms by conspicuously posting the changes on the Pixel by AccessDX Lab website. Continued use of the PWNHealth Services after the effective date of such modified Terms will indicate your acknowledgement and agreement to be bound by the modified Terms. You are expected to check this page from time to time so you are aware of any changes, as they are binding on you. Each version of our Terms will be prominently marked with an effective date at the top of this page. If any of the provisions of these Terms are not acceptable to you, your sole and exclusive remedy is to discontinue your use of the PWNHealth Services.
- PWNHealth Services.
The PWNHealth Services are provided for informational purposes, and do not constitute treatment of any condition, disease or illness. PWNHealth’s physicians do not and will not prescribe or order any drugs or medication in connection with the PWNHealth Services. The PWNHealth Services do not replace your existing primary care or other relationship with your physician. You are solely responsible for forwarding any Results to your primary care or other personal physician and for initiating follow up with such physician for care, diagnosis or medical treatments. PWNHealth will not forward your Results to your personal physician; however you will be provided with Results that you can download and bring to your personal physician. You should not make medical decisions without consulting with a physician. Do not disregard medical advice from your healthcare provider or delay seeking such advice based on the information obtained as a result of your use of the PWNHealth Services. The PWNHealth Services are not intended to make a medical necessity determination for insurance purposes.
By accepting the Terms, you understand that PWNHealth and/or AccessDX Lab may send you messages (including text messages), reports and emails regarding the PWNHealth Services, Tests, Results, and/or any personal or health information you have provided in connection with the PWNHealth Services. You further understand and agree that it is your responsibility to monitor and respond to these messages, reports, and emails.
The PWNHealth Services are not intended or designed for individuals under the age of 18 or the applicable age or majority in the relevant state. By using the PWNHealth Services, you confirm that you are age 18 or over or over the age or majority in your state, as applicable.
The PWNHealth Services are intended for individuals located and residing in the United States. However, the PWNHealth Services may not be available in certain U.S. states. You will be notified if the PWNHealth Services are not available in the state in which you are located. You agree that any and all data you provide or make available in connection with the PWNHealth Services shall relate only to users located in the United States. By using the PWNHealth Services, you confirm that you are located in the United States when you receive the PWNHealth Services. You shall not access the PWNHealth Services outside of the United States and PWNHealth disclaims any responsibility for any attempt by you to do so.
You agree that any data submitted or provided by you or on your behalf in connection with the PWNHealth Services is truthful, accurate, and appropriate. You agree that the PWNHealth Services that you request are for your own personal use and that you will not request a Test for another person.
You may be ineligible for a Test based on the information that you provide or otherwise. You will be notified if it is determined that you are not eligible for a Test.
Information regarding payment is provided on the Pixel by AccessDX Lab website. Payments for the PWN Services are collected by AccessDX Lab on PWN’s behalf.
By continuing with the PWN Services, you understand and agree that you are responsible for paying all fees associated with the PWN Services being offered by PWN, including any fees charged by medical providers and affiliated professional entities for professional services. While we are aware that some health insurance plans may offer coverage for certain COVID-19 services (including testing services) and have waived or reduced patient co-pays associated with such services and testing, the medical providers and affiliated professional entities providing PWN Services for COVID-19 have not contracted with any health insurance plans to make these services available. Accordingly, you agree to pay PWN Remote Care Services or its contractually affiliated professional entities directly for the PWN Services provided to you. You may request that PWN provide you with a detailed accounting of the PWN Services provided to you. This information may enable you to obtain reimbursement for your out-of-pocket expenses from your health insurer. However, the terms and conditions of coverage for COVID-19 services and testing vary by plan, and the COVID-19 services offered by PWN may not be eligible for coverage or expense reimbursement.
The PWN Services are paid for by you and neither the PWN Services nor the tests are intended to be reimbursed by any health plan. PWN does not submit or process insurance paperwork or claims.
- Test Request Evaluation.
PWNHealth affiliated independent physicians evaluate Test requests and determine whether testing is appropriate for you. All PWNHealth Services provided by physicians shall be provided through PWN Remote Care Services or its affiliated professional entities. You will be notified of whether or not your Test request has been approved and ordered. If you have any clinical questions in connection with your Test Request or at any time prior to receiving your results, please contact PWNHealth at the contact information below and you will be connected or directed to a member of the PWNHealth clinical team.
- Results Outreach.
If you receive an abnormal result on a Test, you understand that PWNHealth’s Care Coordination Team may attempt to call you to review the results, offer education and explain the next steps you should take. PWNHealth’s Care Coordination Team may leave you a voicemail but will not include your test results in any voicemail message. You also understand that if you are not able to be reached, PWNHealth’s Care Coordination Team may mail a follow-up letter to the residential address you provided when you purchased my test (the letter will not include your test results). If you receive an abnormal result and have not connected with PWNHealth’s Care Coordination Team, you understand that you should not delay following up with my personal physician). If I have received a positive Test Result on a COVID-19 PCR Test, I will receive a call from a PWNHealth care coordinator as described above; however, if I receive a positive result on a COVID-19 antibody Test, I will not receive a call.
PWNHealth may contact you after via phone, email or messaging to follow up with you on your symptoms and customer satisfaction.
As part of the PWNHealth Services, you are eligible to receive a post-test telehealth consultation (a “Consult”) with a PWN affiliated board certified physician or other healthcare provider licensed in the state where you are located at no additional cost (a “PWN Healthcare Provider”). After you have received your Results, you may arrange a Consult through the PWNHealth Care Coordination Team, either through a call you may receive from the PWNHealth Care Coordination Team regarding your Results or by contacting the PWNHealth Care Coordination Team at the “Contact Us” number below. You will be asked by the PWNHealth Care Coordination Team to complete a brief intake survey to collect necessary health information prior to your Consult, including the state in which you will be located at the time of the Consult. If you have arranged for a Consult, a PWN Healthcare Provider will make up to three (3) attempts to reach you at the contact number you provided. If the PWN Healthcare Provider does not reach you after three (3) attempts, you can contact the PWNHealth Care Coordination Team at the “Contact Us” number below to arrange for additional outreach by a PWN Healthcare Provider. At this time, PWNHealth does not schedule Consults at designated times. During the Consult, you may speak with the physician by phone or video, depending on your state’s regulations.
During your Consult, you may discuss your Test Results, get educational information, and talk about next steps. However, no treatment or prescriptions will be provided during or in connection with the Consult. You will need to follow up with your personal physician for treatment or prescriptions.
PWNHealth may contact you after your Consult via phone, email or messaging to follow up with you on your symptoms and customer satisfaction.
Please review the Notice of Privacy Practices, which describes PWNHealth’s practices regarding the information that PWNHealth may collect from users of the PWNHealth Services. By using the PWNHealth Services, you hereby consent to all actions we may take with respect to your information consistent with these Terms and our Notice of Privacy Practices.
- Limitation of Liability.
IN NO EVENT WILL PWNHEALTH OR ITS AFFILIATES AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, GENETIC COUNSELORS, HEALTHCARE PROVIDERS OR SERVICE PROVIDERS BE LIABLE TO YOU OR TO ANY PARTY FOR ANY CLAIMS, LIABILITIES, LOSSES, COSTS OR DAMAGES UNDER ANY LEGAL OR EQUITABLE THEORY, WHETHER IN TORT (INCLUDING NEGLIGENCE), CONTRACT, STRICT LIABILITY OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, ANY INDIRECT, PUNITIVE, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL, DAMAGES, INCLUDING LOST PROFITS, LOSS OF DATA OR LOSS OF GOODWILL, SERVICE INTERRUPTION, MOBILE PHONE DAMAGE, SYSTEM FAILURE OR THE COST OF SUBSTITUTE PRODUCTS OR SERVICES, OR FOR ANY DAMAGES FOR PERSONAL OR BODILY INJURY OR EMOTIONAL DISTRESS, INCLUDING DEATH, ARISING OUT OF OR IN ANY WAY CONNECTED WITH ANY ACCESS TO OR USE OF (OR INABILITY TO USE) ANY SERVICES. THE PRECEDING DISCLAIMERS AND LIMITATIONS SHALL APPLY EVEN IF PWNHEALTH OR ITS AFFILIATES AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS OR SERVICE PROVIDERS HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES OR LOSSES.
IN NO EVENT SHALL THE TOTAL LIABILITY OF PWNHEALTH AND ITS AFFILIATES AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS AND SERVICE PROVIDERS ARISING IN CONNECTION WITH OR UNDER THESE TERMS EXCEED U.S. ONE HUNDRED DOLLARS ($100 USD). YOU AGREE THAT ANY CLAIM OR CAUSE OF ACTION ARISING UNDER THESE TERMS OR THE PERFORMANCE OR NON-PERFORMANCE OF THE PWNHEALTH SERVICES MUST BE BROUGHT WITHIN ONE (1) YEAR AFTER SUCH CLAIM OR CAUSE OF ACTION ARISES, OR BE FOREVER BARRED.
EXCEPT AS SET FORTH IN THESE TERMS, PWNHEALTH AND ITS AFFILIATES AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS AND SERVICE PROVIDERS HEREBY EXPRESSLY DISCLAIM ALL WARRANTIES OF ANY KIND, WHETHER EXPRESSED OR IMPLIED, AND ALL CONDITIONS WITH REGARD TO THE PWNHEALTH SERVICES AND RELATED CONTENT, INCLUDING, BUT NOT LIMITED TO, ALL IMPLIED WARRANTIES AND CONDITIONS OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, NON-INFRINGEMENT, AND ANY OTHER WARRANTY, WHETHER ORAL OR WRITTEN, WITH RESPECT TO THE PWNHEALTH SERVICES.
PWNHEALTH AND ITS AFFILIATES AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS AND SERVICE PROVIDERS MAKE NO REPRESENTATIONS OR WARRANTIES THAT THERE WILL BE NO DELAY, FAILURE OR CORRUPTION OF DATA TRANSMITTED IN CONNECTION WITH THE PWNHEALTH SERVICES.
PWNHEALTH DOES NOT MAKE ANY REPRESENTATIONS, WARRANTIES OR ENDORSEMENTS REGARDING ANY SERVICES PROVIDED BY THIRD PARTIES INCLUDING, WITHOUT LIMITATION, SERVICES PROVIDED BY AccessDX Lab. PWNHEALTH IS NOT RESPONSIBLE FOR ANY ERRORS OR OMISSION IN THE INFORMATION YOU PROVIDE OR THAT IS PROVIDED TO PWNHEALTH ON YOUR BEHALF.
You agree to defend, indemnify and hold harmless PWNHealth, its subsidiaries and its affiliates, and their respective officers, directors, employees, agents, partners, licensors, physicians, healthcare providers and service providers, from and against any and all claims, actions, demands, liabilities, settlements, costs, or expenses, including, without limitation, reasonable legal fees, legal costs and accounting fees, arising out of, or alleged to arise out of: (i) your violation of these Terms, other policies or any and all applicable laws, rules or regulations; or (ii) your use of materials or features of the PWNHealth Services in an unauthorized manner.
- Ownership; Intellectual Property and Proprietary Rights.
All content, text, graphics, logos, icons and images provided by PWNHealth through or in connection with the PWNHealth Services, and all intellectual property rights therein, and any suggestions, ideas or other feedback provided by you, are the sole and exclusive property of PWNHealth or our service or content providers and are protected by United States and foreign intellectual property laws. The PWNHealth Services also contain proprietary and confidential information that is protected under U.S. and foreign intellectual property laws, including copyright, trademarks, service marks, patents or other proprietary rights and laws.
Except as expressly authorized by PWNHealth, you may not use, sell, modify, reproduce, distribute, create derivative works of or otherwise exploit any information or content made available to you on or through the PWNHealth Services, in whole or in part. PWNHealth grants you a limited, non-exclusive right to access and use the PWNHealth Services solely for personal, non-commercial purposes on the condition that you comply with these Terms. Any use of the PWNHealth Services other than as specifically authorized herein is strictly prohibited.
Certain names, logos, brands and other materials displayed in connection with the PWNHealth Services may constitute trademarks, trade names, services marks or logos (“Trademarks”) of PWNHealth or its affiliates. You are not authorized to use any such Trademarks without the express written permission of PWNHealth or its affiliates. Ownership of all such Trademarks and the goodwill associated therewith remains with us or our affiliates.
PWNHealth and our service providers, and our successors and assigns, may use, copy, reproduce, modify, analyze, perform, display, distribute and otherwise disclose to third parties any data for purposes of providing PWNHealth Services to you; conducting research or analyses of such data; and designing, developing, implementing, modifying and/or improving new, current or future features, products and services of PWNHealth using such data.
All rights not expressly granted in these Terms are reserved.
- Term; Termination.
The Terms, as may be amended from time to time, will remain in full force and effect as long as you continue to access or use the PWNHealth Services, or until terminated in accordance with the provisions of these Terms. We, in our sole discretion, with or without notice to you, at any time and for any reason, may terminate, suspend or modify: (i) any of the rights granted by these Terms; (ii) the permission granted to you to access and/or use the PWNHealth Services; and (iii) the PWNHealth Services. You may terminate the Terms at any time by discontinuing use of the PWNHealth Services. Your permission to use the PWNHealth Services automatically terminates if you violate these Terms. PWNHealth shall not be liable if, for any reason, all or any part of the PWNHealth Services is unavailable. Upon termination of these Terms, any provision that by its nature or express terms should survive will survive such termination.
- Equitable Relief.
You acknowledge and agree that breach of these Terms will result in irreparable harm that would be difficult to measure; and, therefore, that upon any such breach or threat of such breach, PWNHealth shall be entitled to seek injunctive and other appropriate equitable relief from any court of competent jurisdiction (without the necessity of proving actual damages or of posting a bond), in addition to whatever remedies it may have at law, under these Terms, or otherwise.
These Terms, the PWNHealth Notice of Privacy Practices, consents and any other agreements incorporated by reference herein constitute the entire agreement between you and PWNHealth with respect to access to and use of the PWNHealth Services. These Terms and your use of the PWNHealth Services are governed by the laws of the State of Delaware, without respect to its conflict of law principles. In the event a dispute arises between the parties under these Terms or that in any way relates to your use of the PWNHealth Services, the parties hereby agree to binding arbitration, which will be conducted in New York, New York, in accordance with the Commercial Arbitration Rules of the American Arbitration Association. If any provision of these Terms is found to be invalid or unenforceable by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of these Terms, which shall remain in full force and effect. No waiver of any of these Terms shall be deemed a further or continuing waiver of such term or condition, or of any other term or condition. You may not assign or transfer your rights or obligations under these Terms without our prior written consent, and any assignment or transfer in violation of this provision shall be null and void. There are no third-party beneficiaries to these Terms. PWNHealth may freely assign or transfer these Terms without restriction. Subject to the foregoing, these Terms will bind and inure to the benefit of the parties, their successors and permitted assigns.
- Contact Us.
Should you have questions about the PWNHealth Services, including about your Test or Results, you may contact us at:
For COVID-19 Tests: firstname.lastname@example.org
For all other Tests:
Email Address: email@example.com
Phone Number: 888-362-4321
Address: PWNHealth, LLC
123 W 18th Street
New York, NY 10011
Last updated: June 15, 2020
PWNHealth Notice of Privacy Practices Regarding Health Information
(Effective April 30, 2019)
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
How We May Use and Disclose your Health Information. PWN Remote Care Services, P.A., PWN Remote Care Services, P.C., PW Medical Professional and certain other affiliated professional entities and PWNHealth, LLC (the administrative services provider of the professional entities) (collectively, “PWNHealth”, “we” or “us”) may use your health information and disclose it to appropriate persons, authorities and agencies, as allowed by federal and state law. Please be aware that state and federal law may have more requirements on how we use and disclose your health information. If there are specific, more restrictive requirements, even for some of the purposes listed above, we may not disclose your health information without your written permission as required by such laws. We may also be required by law to obtain your written permission to use and disclose your information related to treatment for a mental illness, developmental disability, or alcohol or drug abuse. We may do this without your written permission for the following limited purposes:
- Required by Law.
- Public Health.
- Reporting Victims of Abuse or Neglect.
- Health Care Oversight.
- Legal Proceedings & Law Enforcement.
- Serious Threats to Health or Safety.
We may also disclose any information that you provide to use or that is provided on your behalf. You have the right to request a restriction or limitation on the disclosure of such information as set forth below.
Your Health Information Rights.
You have the right to:
- Read and copy your health information.
- Request to correct your health information.
- Request to restrict certain uses and disclosures of your information. You have the right to request in writing that we restrict how your health information is used or disclosed. For most requests, under the law, we are not required to agree to your request. In some cases, we may not be able to agree to your request because we do not have a way to tell everyone who would need to know about the restriction. There are other instances in which we are not required to agree with your request. We will inform you when we cannot find a way to carry out your request.
- Receive a record of how we disclosed your information.
- Receive notification of a breach and obtain a paper copy of this notice.
- Contact us at firstname.lastname@example.org or PWNHealth, 123 W 18th Street, New York, NY 10011 Attn: Privacy Officer with any questions or concerns regarding the above.
PWNHealth Informed Consent
PWNHEALTH WILL NOT PROVIDE ANY SERVICES FOR MEDICAL EMERGENCIES OR URGENT SITUATIONS. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL YOUR DOCTOR OR 911 IMMEDIATELY.
YOU SHOULD CONTACT YOUR HEALTHCARE PROVIDER IF YOUR SYMPTOMS GET WORSE OR YOU EXPERIENCE ANY NEW SYMPTOMS.
BY CLICKING “I ACCEPT,” YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS INFORMED CONSENT. IF YOU DO NOT CLICK “I ACCEPT”, YOU WILL NOT BE ABLE TO USE OR RECEIVE THE SERVICES.
General Informed Consent
I agree to receive the services provided by PWNHealth (the administrative services provider of the professional entities), PWN Remote Care Services, PW Medical Professional and certain other affiliated professional entities (collectively, “PWNHealth”, “we” or “us”) relating to physician oversight of laboratory tests (“Tests”), including, without limitation, evaluation of the test request, ordering of Tests (if appropriate), receipt of Test results (“Results”), consultations via telemedicine with physicians or healthcare providers (“Consults”), customer support or counseling and any other related services provided by PWN or its service providers (the “PWNHealth Services”). All clinical services, including services provided by physicians, will be provided through PWN Remote Care Services, PW Medical Professional or their contractually affiliated professional entities.
If you have ordered an HIV Test (including as part of a panel), please also review the Informed Consent to Perform HIV Testing immediately following this General Informed Consent.
I acknowledge and agree to the following:
- I am the individual who will provide the sample for the Test(s) that I am requesting.
- I am at least eighteen (18) years of age.
- I have read and understand the information provided about the Test(s) that I have been provided on the Pixel by AccessDX Labwebsite. For COVID-19 testing, additional information is also available at the CDC website https://www.cdc.gov/coronavirus/2019-ncov/index.html.
- In order to utilize the PWNHealth Services, I must provide an appropriate sample for the Test(s), which may include a blood, urine, saliva or other sample.
- The information I have provided in connection with the PWNHealth Services is correct to the best of my knowledge. I will not hold PWNHealth or its health care providers responsible for any errors or omissions that I may have made in providing such information.
- My health information and results may be shared with other PWNHealth health care providers, including physicians, and counselors for purposes of providing care to me.
- The PWNHealth Services do not constitute treatment of any condition, disease or illness.
- While PWNHealth and the laboratories implement safeguards to avoid errors, as with all laboratory tests, there is a chance of a false positive or false negative result.
- I am responsible for checking for results notification and logging on to my Pixel by AccessDX Lab account to view my results when available.
- If I receive an abnormal Test Result, I understand that a PWNHealth care coordinator may attempt to call me to review the results, offer education and explain the next steps I should take. The PWNHealth care coordinator may leave me a voicemail but will not include my test results in any voicemail message. If I receive an abnormal result and have not connected with a PWNHealth care coordinator, I understand that I should not delay following up with my personal physician. I also understand that if I am not able to be reached, PWNHealth’s Care Coordination Team will mail a follow-up letter to the residential address I provided when I requested my Test (the letter will not include my Test Results). If I have received a positive Test Result on a COVID-19 PCR Test, I will receive a call from a PWNHealth care coordinator as described above; however, if I receive a positive result on a COVID-19 antibody Test, I will not receive a call.
- I understand that after receiving my Results, I will have the opportunity for a telemedicine Consult with a PWNHealth physician or other licensed healthcare provider to answer any questions I may have.
- I certify that throughout the duration of the PWNHealth Services I receive, including my Consult, I will be physically present in the state of residence I provided or other state of which I have notified PWNHealth.
- I am responsible for forwarding any results to my primary care or other personal physician and for initiating follow up with such physician for care, diagnosis or medical treatment.
- I will not make medical decisions without consulting a healthcare provider or disregard medical advice from my healthcare provider or delay seeking such advice based on information as a result of the use of the PWNHealth Services.
- If I receive an abnormal result on certain STD Tests or if I receive a Test Result for a COVID-19 Test (PCR and antibody Tests), my name, Test Result and other required information may be disclosed to federal or state health agencies in accordance with applicable law.
- If I receive an abnormal result on an STD Test, it is important that I notify my sexual and needle sharing partners and follow up with my personal physician to receive treatment.
I understand that PWNHealth Services, including Consults, are delivered by health care providers who are not in the same physical location as I am using electronic communications, information technology or other means, including the electronic transmission of personal health information. I also understand that:
- A PWN physician will determine whether or not Test(s) and PWNHealth Services are appropriate for me.
- For Consults, the scope of services will be at the sole discretion of the healthcare provider conducting the Consult, with no treatment or prescription. The healthcare provider will determine whether or not the PWNHealth Services being rendered are appropriate for a telehealth encounter.
- I have the right to withdraw my consent to the use of telehealth in the course of my care at any time by contacting the PWNHealth’s Care Coordination Team at the email address below.
- Any video feed from the Consult will not be retained or recorded by PWNHealth.
- I may need to see a health care provider in-person for diagnosis, treatment and care.
- There are potential risks associated with the use of technology, including disruptions, loss of data and technical difficulties.
- There are alternative services, such as visiting a primary care provider, an emergency room, or an urgent care facility; however, I chose to proceed with the PWNHealth Services at this time.
I understand that if I have any questions before or after my Test, I can contact PWNHealth at the email address or phone number below and I will be connected or directed to a member of the PWNHealth Care Coordination including a physician, if requested or as otherwise applicable.
I authorize PWNHealth to use the email address and phone number I provided at the time I requested the Test on the Pixel by AccessDX Lab website (or that I updated by contacting PWN at the email below) to contact me in connection with the PWNHealth Services, including followup after a Consult. I am responsible for contacting PWN at the email address below to notify them of any changes to my mailing address, email address, phone number or other information that I provided in connection with the PWNHealth Services.
I understand that testing is voluntary and that I may withdraw my consent to testing at any time prior to the completion of the Test(s) by contacting PWNHealth’s Care Coordination Team at the email address below.
I specifically authorize the transfer and release of my information as described herein and in the PWNHealth Notice of Privacy Practices, including my medical history that I provided, my Test Results and other identifiable health information, submitted by me or about me in connection with the PWNHealth Services, to, between and among myself and the following individuals, organizations and their representatives: (a) AccessDX Lab and its affiliates, their staff and agents; and (b) PWNHealth and its affiliates, and their staff, agents, and health care providers, including physicians to facilitate and execute the PWNHealth Services requested by me or performed with my consent and as required or permitted by law.
I understand that I have a right to receive a copy of the above data disclosure authorization. I have the right to refuse to agree to this authorization in which case my refusal may affect the PWNHealth Services provided to me. When my information is used or disclosed pursuant to this authorization, it may be subject to re-disclosure by the recipient and may no longer be protected by privacy laws. I have the right to revoke this authorization in writing at any time, except that the revocation will not apply to any information already disclosed by the parties referenced in this authorization. This authorization will expire ten (10) years from the date of signature.
My written revocation must be submitted to PWNHealth’s General Counsel at:
PWN Remote Care Services
c/o PWNHealth, LLC
Attn: General Counsel
123 West 18th Street, 8th Floor
New York, NY 10011
For COVID-19 Tests: email@example.com
For All Other Tests: firstname.lastname@example.org or 888-362-4321
Informed Consent to Perform HIV Testing
(This Consent Applies Only If You Purchase An HIV Test)
I have been provided with and I understand the following information regarding HIV testing:
- What is HIV? HIV stands for human immunodeficiency virus. It’s the virus that causes AIDS. It damages your immune system, making it easier for you to get sick and even die from infections or diseases, like cancer, that your body could normally fight off.
- How does the test work? The HIV test is a blood test that looks for HIV and requires you to provide a sample of your blood. The test is divided into three parts to ensure accuracy. The first test looks for antibodies your body makes when have been infected with HIV, as well as part of the virus itself. If the result of the first part is non-reactive, you are not infected with the HIV virus. If it is reactive, a second test, which looks for antibodies against HIV, is run from the same blood sample. If this test is reactive, it is highly likely you are infected with the HIV virus. If it is non-reactive or indeterminate, a third test is run. This last test looks for RNA, HIV’s genetic material. If this test is positive, then it confirms that there is HIV infection. Another test may be recommended if all three parts of the test are negative but there is still a strong reason to think you have been infected.
- Timing of Testing. After being infected with HIV, it takes several weeks and possibly months for blood tests to detect the virus. If you test too soon, the test may be negative even if the virus is in your body. If you think you may have been exposed to HIV in the last 3 days, you should immediately contact a doctor. Prompt treatment, also called post-exposure prophylaxis (PEP), within 3 days of a possible exposure, can decrease the chance that you will develop an HIV infection.
- Test Results and Counseling. If your test shows that you have HIV, PWNHealth’s Care Coordination Team will call you to review the results and explain the next steps you should take, including where you can get treatment. After your test you will be offered education, counseling, and information regarding your results.
- Treatment of HIV. There are treatment options for HIV. There’s no cure for HIV, but medication can slow down the damage the virus causes. New medications have made it possible for people with HIV to live about as long as they would without HIV. Getting tested means getting treatment that will help you stay healthy longer and lower the chances of spreading the virus to others.
- Safe Practices. Individuals with HIV/AIDS can adopt practices to protect uninfected people from becoming infected. Use condoms every time you have sex.
- Partner Notification. If you test positive, it is important to notify your sexual and needle sharing partners and many states require that you do so. There are resources available from your local health department which can help you notify your partners. Be honest with your future partners so you can both be informed and help each other stay healthy.
- Further Testing. Even if your test results are negative, the CDC recommends yearly testing for some people, including those with multiple sex partners, men who have sex with men, those who use IV drugs, and those who’ve had another STD. Ask your doctor if you should be tested every year.
- Additional Information. Additional information is available at the Pixel by AccessDX Lab website.
I understand that if I have any questions before or after the HIV test, I can contact PWNHealth’s Care Coordination Team by calling by calling 888-362-4321 or emailing email@example.com.
I understand that the testing being offered is confidential but not anonymous. It requires my name and credit card information. Anonymous testing options are available at in-person specialized testing centers.
I understand that the law prohibits discrimination based on an individual’s HIV status. Services are available if I believe I have experienced discrimination based on my HIV status.
I understand that the law protects the confidentiality of test results. As required by state law, if I am positive for HIV, my name and results will be reported to my state’s health department. I also understand that my health information and results may be shared with other PWNHealth health care providers, including physicians, and counselors for purposes of providing care to me.
I understand that testing is voluntary and that I may withdraw my consent to testing at any time prior to the completion of the laboratory test by contacting PWNHealth’s Care Coordination Team by calling by calling 888-362-4321 or emailing firstname.lastname@example.org.
I have read and understand the information that has been provided to me. I have been given the opportunity to ask questions about HIV testing and all of my questions have been answered to my satisfaction.