Blood Tests and Samples. I authorize Certified Dermatologists to order blood samples for testing of communicable or sexually transmitted diseases including, but not limited to HIV and Hepatitis, if a physician orders the test for diagnostic purposes for me or the patient named below or in the event a health care worker has been exposed to my blood or bodily fluids or the blood or bodily fluids of the patient named below. I authorize Certified Dermatologists and my, or the below named patient’s, physician, dentist, surgeon, or podiatrist to have the results of these tests. Except when an HIV test is performed in a medical emergency and the test results are medically necessary to avoid or minimize an immediate danger to me, or the patient named below, or others, I understand that in Ohio, I, or the patient named below, have the right to an anonymous HIV test.
Blood Tests and Samples. I authorize Cerﳳfied Dermatologists to order blood samples for tesﳳng of communicable or sexually transmiﹷed diseases including, but not limited to HIV and Hepaﳳﳳs, if a physician orders the test for diagnosﳳc purposes for me or the paﳳent named below or in the event a health care worker has been exposed to my blood or bodily fluids or the blood or bodily fluids of the paﳳent named below. I authorize Cerﳳfied Dermatologists and my, or the below named paﳳent’s, physician, denﳳst, surgeon, or podiatrist to have the results of these tests. Except when an HIV test is performed in a medical emergency and the test results are medically necessary to avoid or minimize an immediate danger to me, or the paﳳent named below, or others, I understand that in Ohio, I, or the paﳳent named below, have the right to an anonymous HIV test.
