Hello Woodside students, faculty, staff and parents!
Thank you for taking the time to complete the Worksite Labs consents within this form. This message will provide a quick overview of what's in the form, and how you can be best prepared to complete the process in a single sitting. You do have the option to save your progress and finish the form at a later time.
Please note that this form does need to be completed prior to administering testing services. It should take about 10 minutes to complete and will require the following information:
1. Basic Contact Info (Name, Phone Number, Email, Address)
2. Student/Faculty/Staff ID #
3. Insurance ID Card (if you are insured)
4. Government Issued ID (if you are un-insured)
5. Optional: Vaccination Card (if applicable)
There are 7 pages total:
1. Contact & Basic Information
2. Vaccination Status
3. Informed Consent for COVID-19 Diagnostic Testing
4. HIPAA Authorization for Use or Disclosure of Health Information
6. Request for Insurance Information
7. Assignment of Insurance Benefits
You will receive a notification of your form submission with an encrypted PDF attached for your records. Please check your spam folder if you do not receive the email within 5 minutes.
If you have any questions, please contact email@example.com.