I hereby give my consent to undergo COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) test with Medical Center Paranaque. Specifically, I consent for the Hospital to take the required specimens for the test, who may send the same to Medical Center Paranaque (Provider), or another accredited molecular laboratory, at the exclusive discretion of the Hospital, to subject the specimens to the RT-PCR test. I further consent and allow Medical Center Paranaque, and/or the other molecular laboratory who subjected my specimens to the RT-PCR test, to submit my test results to the Hospital and to the Department of Health (DOH), in compliance with the provisions of DOH Administrative Order No. 2020-0013 entitled “Revised Guidelines for the Inclusion of COVID-19 in the List of Notifiable Diseases for Mandatory Reporting to the Department of Health”. I shall indemnify and hold harmless the Hospital and Provider, their officers, employees or agents from any and all claims and actions damages, lawsuits or liabilities for personal injuries or loss resulting from acts or omissions of anyone under the hospital’s supervision or control, and/or from any and all claims and actions damages, lawsuits or liabilities in connection with the accuracy of the RT-PCR test. I hereby declare that I have read this document, the contents hereof were translated to me, and understood the same, before signing it and the quitclaim hereby given is made willingly and voluntarily and with full knowledge of my rights under the law. *
