Form CT-29 "Human Immunodeficiency Virus (Hiv) Antibody Test Consent Form (Rapid Testing) (Confidential Testing Only)" - New Jersey

What Is Form CT-29?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2012;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CT-29 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form CT-29 "Human Immunodeficiency Virus (Hiv) Antibody Test Consent Form (Rapid Testing) (Confidential Testing Only)" - New Jersey

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Human Immunodeficiency Virus (HIV) Antibody Test
Consent Form (Rapid Testing)
(Confidential Testing Only)
When infected with HIV, the body produces proteins called antibodies. This test is looking for those antibodies.
This is not a test for AIDS – only a doctor can make that diagnosis.
I understand a rapid test will be performed which will use a specimen from a drop of blood from my finger, a swab
from the inside of my mouth, or from blood drawn from my arm.
I understand I will receive a test result today.
If I receive a Negative test result it means that I am not at this time HIV infected. Although, since it
takes time for antibodies to develop, I will have to take another test if I was exposed within the last
3-6 months.
If I receive a Preliminary Positive test result it means there is a very good possibility that I am
infected with HIV. It also means I would need to have blood drawn from my arm and/or a drop of
blood from my finger for a second test. This is the best way of making sure the information given to
me is accurate. If blood is drawn from my arm, it will be sent to a laboratory and I will need to return
to the clinic in about 2-3 days to receive the result. If a drop of blood is taken from my finger to
perform a second rapid test, I will receive the results in about 20 minutes.
I understand I will test confidentially, which means I will sign my name and provide my address and telephone
number on this form. This is the best way for me to enter into treatment, if necessary, and to learn of other
services. It is also a way for someone to reach me if I do not return to receive a confirmatory result.
A coded number will be assigned and used to identify me. The coded number will be placed on this consent form
and on all the testing materials. If a confirmatory test is necessary the same coded number will be placed on the
tube of blood and on the laboratory slip that will be sent to the laboratory. All records in this clinic are maintained
as confidential and kept under lock and key.
I understand that if I receive a second positive test result, it will be reported to the New Jersey Department of
Health as required by law. Any other release of this information will require my written consent, a court order, or a
subpoena.
I have read or someone has read this form to me. A counselor has answered all of my questions and I have
decided to test for HIV. I will give my permission to test by signing the form below.
___________________________________
___________________________________
(Signature of Witness)
(Signature of Client or Guardian)
___________________________________
___________________________________
(Coded Number)
(Client’s Street Address)
___________________________________
___________________________________
(Date)
(City and State)
___________________________________
(Telephone Number)
CT-29
JUL 12
Human Immunodeficiency Virus (HIV) Antibody Test
Consent Form (Rapid Testing)
(Confidential Testing Only)
When infected with HIV, the body produces proteins called antibodies. This test is looking for those antibodies.
This is not a test for AIDS – only a doctor can make that diagnosis.
I understand a rapid test will be performed which will use a specimen from a drop of blood from my finger, a swab
from the inside of my mouth, or from blood drawn from my arm.
I understand I will receive a test result today.
If I receive a Negative test result it means that I am not at this time HIV infected. Although, since it
takes time for antibodies to develop, I will have to take another test if I was exposed within the last
3-6 months.
If I receive a Preliminary Positive test result it means there is a very good possibility that I am
infected with HIV. It also means I would need to have blood drawn from my arm and/or a drop of
blood from my finger for a second test. This is the best way of making sure the information given to
me is accurate. If blood is drawn from my arm, it will be sent to a laboratory and I will need to return
to the clinic in about 2-3 days to receive the result. If a drop of blood is taken from my finger to
perform a second rapid test, I will receive the results in about 20 minutes.
I understand I will test confidentially, which means I will sign my name and provide my address and telephone
number on this form. This is the best way for me to enter into treatment, if necessary, and to learn of other
services. It is also a way for someone to reach me if I do not return to receive a confirmatory result.
A coded number will be assigned and used to identify me. The coded number will be placed on this consent form
and on all the testing materials. If a confirmatory test is necessary the same coded number will be placed on the
tube of blood and on the laboratory slip that will be sent to the laboratory. All records in this clinic are maintained
as confidential and kept under lock and key.
I understand that if I receive a second positive test result, it will be reported to the New Jersey Department of
Health as required by law. Any other release of this information will require my written consent, a court order, or a
subpoena.
I have read or someone has read this form to me. A counselor has answered all of my questions and I have
decided to test for HIV. I will give my permission to test by signing the form below.
___________________________________
___________________________________
(Signature of Witness)
(Signature of Client or Guardian)
___________________________________
___________________________________
(Coded Number)
(Client’s Street Address)
___________________________________
___________________________________
(Date)
(City and State)
___________________________________
(Telephone Number)
CT-29
JUL 12