Concent

 

• If you are over 18 years of age, the word ‘You’ in this form refers to the Individual considered for the screening test. 
• If a family member or friend or differently-abled individual is being considered for a screening test, the term “You” in this form refers to the legal guardian of the individual undergoing the screening test.
• The words ‘We’, ‘Our’, “Us” refer to IOTA Diagnostic Pvt. Ltd. 

 

You hereby consent to undergo HPV screening test offered by us and understand that

1. You will self-collect your biological sample(s) using a specially designed kit. To ensure accurate sampling, please carefully follow the instruction manual and demonstration video provided.
2. You understand that the sample(s) will be used to determine if you and/or your family members have HPV (Human Papillomavirus) variants in the collected menstrual blood. 
3. The screening test report will be usually released within the Turnaround Time (TAT) specified by us for the test. 
4. A positive test result indicates that the individual being tested has an HPV variant that might have implications for their health. Consultation can be sought from any physician or medical counselor of your choice. You may also wish to consider independent testing and consultation in addition to this screening test.
5. The report will be shared with your authorized physician where applicable, or shared to your registered email ID, or shared to your registered phone, or a hard copy of the report can be shared upon request to the address provided in this form.
6. All raw data are confidential and will not be released unless a special written request is made by you or the consulting clinician on record, or a valid court order is received by us.
7. Samples collected will be sent to our authorized laboratory partner for the testing, and the samples shall be stored and processed according to the laboratory guidelines.  
8. You understand and agree to the use of your data and biological sample for future research by us and our partner. 
9. Sharing of data with our partners will be bound under a data access agreement that will impose similar obligations of maintaining individual confidentiality. Your personal identity will not be revealed in any information shared with third parties or published; your data will be coded accordingly. 
10. The future use of your data or sample in research may result in commercial gains. Based on the nature of research outcomes, further investments by us may be needed to commercialize these outcomes. You will not have the right to participate in any direct monetary gains resulting from any future commercial activity. 

 

I hereby give my consent to IOTA Diagnostic Pvt. Ltd to use my sample for the HPV Screening testing or research purposes (if required) related to the subject matter of this Informed Consent Form.