HIV Testing Consent (only applies when ordering an HIV test)

The purpose of this form is to document that I have requested that a blood test for the Human Immunodeficiency Virus be performed.  The blood test(s) are used to detect HIV antibody or DNA.  HIV is the cause of Acquired Immune Deficiency Syndrome (AIDS).  I understand that the test is performed by drawing blood from the arm and processing the resulting blood specimen by ELISA, Western Blot, or other laboratory technology.

This consent serves as notice that I have been informed that the tests can produce false positive and false negative results.   For HIV, the ELISA screening test produces three false “positive” (indicating the presence of an anti-HIV when it is not present) test result in every 10,000 specimens processed, regardless of the population tested.  Also, I have been informed that, if positive, the ELISA test will be repeated, and if still positive, a secondary level test (Western Blot) will then be performed.  The combination of these two tests reduces the possibility of a false positive HIV antibody result to a very small fraction per 10,000 tests performed.

This consent serves as notice that I have been informed that the ELISA screening test fails to detect anti-HIV for a period of time immediately after infection with the virus.  I have been offered re-testing if it is suspected that this has occurred.  The ELISA screening test may fail to detect anti-HIV in rare cases. 

This consent serves as notice that I have been informed that positive test results must be reported to the appropriate State Health Agency.  Confirmed HIV antibody test results will be made available beyond that only in summary or statistical form in such a way as to preserve my confidentiality.

I have read the previous information and I understand it.  By checking the box on the order form I acknowledge that I have been given all of the information requested concerning the blood test and the release of the results. 

I acknowledge that I have given my consent for the performance of an HIV blood test, and the release of the results as described above.