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Notice of Privacy Practices

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.


Notice of Informed Consent

Confidentiality & Liability
IU Health is a HIPAA compliant organization dedicated to keeping your personal health information/results confidential. The information will be used to improve programs and to develop new ones to better meet your needs. Information from this screening is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions nor is it intended to create a patient-provider relationship. The information should not be used in place of a visit, call, consultation or advice of your physician or other health care provider. IU Health does not recommend the self-management of health problems. Information from this screening is not exhaustive and does not cover all diseases, ailments, physical conditions or their treatment. Should you have any health care-related questions, please call or see your physician or other health care provider promptly. You should never disregard medical advice or delay in seeking it. Neither IU Health nor its affiliates ("IU Health") shall be responsible for information provided through this screening under any theory of liability or indemnity.

Purpose, Procedures & Risks
You are being provided with an opportunity to obtain multiple health screenings that could include a serum “blood” A1C reading. Some procedures may involve a blood sample obtained from a finger stick. A lancet, which is a sterile pin, is used to obtain the specimen. The area of the finger from which the specimen is obtained is cleaned with alcohol. There are minimal risks associated with these tests. Since a finger stick creates an opening in the skin, there is a chance of infection. Additionally, there is the risk of minor discomfort or pain. Any redness, swelling, discharge or continued pain should be reported to your physician.

What to Do with the Results
Please share these results with your physician.

Voluntary Consent
I am 18 years or older and consent to participate in this health screening. I acknowledge being offered the IU Health Notice of Privacy Practices. If I choose to discontinue any test at any time I will inform the screener and the test will be stopped.


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