Warren County

COVID-19 Patient Testing

Consent Form

I authorize a nasopharyngeal swab for COVID-19 Test as ordered by my physician or authorized healthcare provider (or my child's or legal dependent's physician or authorized healthcare provider). I further understand, agree, certify, and authorize the following:

• The patient for whom the appointment is being made is a resident of Warren County, NJ and has been screened and pre-approved by a St. Luke's Primary Care Physician.
• I am the parent or legal guardian (if the patient is a minor or dependent) of the patient named above.
• I authorize the County of Warren to collect my or my child/dependent's specimen. (nasopharyngeal swab).
• The County of Warren has contracted with BioReference Laboratories for laboratory analysis and report of my, my child's, or dependent's specimen. I authorize BioReference Laboratories to perform testing on my specimen.
• I understand that processing of the specimen and results may take between 3 to 7 days.
• The Warren County Health Department will release the results of my test only to my physician or authorized healthcare provider who ordered testing. I authorize BioReference Laboratories and/or St. Luke's Health System to release test results or other information necessary to the Warren County Health Department to process said release of test results.
• I understand that the physician or authorized healthcare provider identified in this online application will be responsible for providing testing results, interpreting test results, explaining testing limitations, and providing any additional diagnostic or clinical services.

By selecting YES on the "I have read and agree to the Consent Form" field when making an on-line appointment, I acknowledge that I have read, understand, agree, certify, and/or authorize the information above and further agree to hold harmless the County of Warren, BioReference Laboratories and the St. Luke's Health System, including its employees, agents, and contractors from any and all liability and claims.