Invitae Consent for Genetic Counseling and Telehealth
This consent is for the provision of telephone genetic counseling by Invitae Corporation (“Invitae”) and its genetic counselors.
You should share complete and accurate medical history and details regarding any conditions you may have or may be aware of in your family. The recommendations from your genetic consultation will depend on the accuracy of your family history. Issues of non-paternity (for example, named father is not the biological father) will affect the evaluation of your family history. We may request that you obtain genetic test results or medical records from a family member, if possible, in certain circumstances.
In the unlikely event of the telemedicine session being interrupted due to a technological problem or equipment failure, the appointment may be rescheduled.
While telehealth may improve access to care and lead to more efficient diagnosis, treatment, and care management, there are potential risks associated with telehealth, as there are with any medical treatment or procedure. The potential risks associated with telehealth include, but are not limited to: insufficient transmission of information that does not allow for appropriate decision-making and diagnosis by the health care provider; delays in diagnosis, consultation, and/or communication due to deficiencies or failures of equipment or systems; failure of security protocols, resulting in a breach of privacy of personal health information; or adverse results or reactions due to lack of access to complete medical records.
Under certain circumstances, telehealth may not be as appropriate as face-to-face interaction, and your Invitae genetic counselor may refer you to another provider for follow-up or additional care. You can always choose to receive in-person care, even after consenting to receive services via telehealth.
The details of your telehealth interaction, which may include oral, written, and electronic communications between you and your health care provider, will become part of your medical records, as such details would for any other type of face-to-face interaction with a health care provider.
You may discuss any questions regarding this consent form with the staff at Invitae (415) 854-5101.
STATEMENT OF CONSENT
I have read and fully understand this informed consent document relating to genetic counseling and telehealth and the risks described in this consent. I wish to proceed with the genetic counseling session.
Estimate your out-of-pocket cost for Invitae tests related to a personal or family history of
breast, ovarian, colorectal, or uterine cancer.
Based on the insurance provided, the out-of-pocket cost estimate is
The amount shown above is an estimate of your out-of-pocket cost based upon the
information you entered about your health insurance coverage. It is not a confirmation
that the test has been authorized by your insurance provider. Your final cost may
vary based upon your health plan design, deductible, co-insurance, and out-of-pocket limits.
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As part of Invitae’s dedication to making high-quality genetic testing affordable and
accessible, we also offer a patient pre-pay option of $250.
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