Section 32. 1-45. 1(A) and (B). Code of VA (1950, as amended) provides
that in the event of significant exposure (e.g. needle stick) consent for
testing for Human Immunodeficiency Virus (HIV), Hepatitis B Virus and Hepatitis
Virus is considered to have been given by the patient and/or healthcare
worker granting the hospital the right to perform such tests. Test results
are confidential and can only be released in accordance with the applicable
laws and the policy of the local hospital.
I acknowledge that I have reviewed ALL questions/ alerts on this questionnaire
and responded accordingly. There are no other medical conditions or medications/
allergies that have not been listed. I am aware that I must notify the
practice of any future changes. This will serve as my electronic signature.