STEP 1: HIPAA Authorization for the Disclosure of Health Information
By signing this Authorization, I acknowledge that I have read and understand this Authorization. Further, I authorize the disclosure of the information set forth herein in accordance with the terms of this Authorization.
Each attendee must submit their own COVID-19 test record labeled with their full name and date of test to receive record verification.
All pictures of self-administered tests must have your first and last name, and date of test to be verified.
If you are submitting a COVID-19 test result record from a clinic, the record submitted must include your first and last name, date of test, type of test, and the clinic name.
By signing below, I acknowledge and agree that I have read the Agreement and agree to all terms contained therein.
If you encounter any problems with uploading your submission, please contact email@example.com and enter your event name in the subject line.