You agree to receive the services provided by DMG, PROMERO, and certain other affiliated professional entities (collectively, “DMG”, “we” or “us”) relating to scheduling appointments for diagnostic testing for COVID-19 (“Test”), including, without limitation, creation of a user profile, participation in a survey to evaluate symptoms based on CDC guidelines, scheduling of a Test (if appropriate), receipt of Test results (“Results”), which may involve the storage of personal health and other information protected under federal and state laws, and you expressly authorize the sharing and reporting certain personal health and other information (the “DMG Services”). All testing for COVID-19, including services provided by physicians at testing sites, will be provided through outside third-party organizations

You acknowledge and agree to the following:

• • You are (or your child or legal dependent is) the individual who will provide the sample for the Test that you are requesting.
  • You are the parent or legal guardian (if the individual providing the same is a minor or dependent) of the individual who will provide the sample for the Test that you are requesting.
  • You have read and understand the CDC information provided about testing on DMG’s website, including the following links:
    • https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html
    • https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/index.html
  • The information you have provided in connection with the DMG Services is correct to the best of your knowledge. You will not hold DMG responsible for any errors or omissions that you may have made in providing such information.
  • Your personal health and other information and results may be shared with other local, state and federal departments of health, research facilities, and health care providers, including physicians, and counselors for purposes of providing care to you, and for compliance with COVID-19 reporting requirements.
  • The DMG Services do not constitute treatment of any condition, disease or illness.
  • DMG Services for scheduling are not determinative and are solely a recommendation of if you should consider testing. These recommendations are no way an indication of if you are likely to test positive or negative for COVID-19. Even after your testing is completed with an approved testing facility, there is a chance of a false positive or a false negative result. You are responsible to follow up with the testing facility if you do not receive results within twenty four (24) hours after you provide your sample.
  • You are responsible for checking the scheduling mobile application or your e-mail for notice of where your results notification is available and options for viewing your results when available.
  • You are 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 treatment.
  • You 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 DMG Services.
  • If You receive an abnormal result, your name, result and personal health or other information may be disclosed to my state health agency in accordance with applicable law.
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You understand that Test results are provided independent of DMG Services, and will be delivered by health care providers who may not be in the same physical location as you, may be using electronic communications, information technology or other means, including the electronic transmission of personal health information. You also understand that:

• • Your personal health and other information pertaining to the DMG services are governed by the DMG Terms of Use, Notice of Privacy Practices, and Privacy Policy.
  • You may need to see a health care provider in-person for diagnosis, treatment, and care. You authorize DMG to use the email address and phone number you provided at the time you requested the Test (or that

You updated by contacting DMG) to contact you in connection with the DMG Services. You are responsible for updating your user account or contacting DMG to notify them of any changes to your mailing address, email address, phone number or other information that you provided in connection with the DMG Services.

You understand that testing is voluntary and that you may withdraw your consent to testing at any time prior to the completion of the Test by cancelling your testing appointment through the mobile application.

By selecting YES on the “I have read and agree to the Consent Form” field when making an on-line appointment, you acknowledge that you have read, understand, agree, certify, and/or authorize the information above and further agree to hold harmless DMG including its employees, agents, and contractors from any and all liability and claims.