TECHMED HEALTH CENTRE AND DIAGNOSTIC (P) LTD

HIV CONSENT FORM

.ஐ. . ஒப்புதல்

This is to confirm that:

 I have been informed in the language I can understand about the nature of HIV test and the
consequences of either positive or a negative report.

.ஐ. (HIV) ( )

( ) .

 I am subjecting myself for HIV testing on my own free will and I am not being compelled to do this
test either by my doctor, family members, friends or the laboratory.

.ஐ. (HIV) ( ,

, , ) .

 I understand that this test may not be conclusive because a positive result means additional tests
may be needed and negative result does not necessarily eliminate consideration of AIDS.

.ஐ. . ( ) ,

( ) .

I hereby give my consent for the performance of the HIV Blood test.
.ஐ. . (HIV) .

Name: ___________________________ Signature: _______________________ Date: ___________

Referred By (Dr.) :

Hospital/Clinic/Lab Name: