I give Cibola General Hospital permission to draw blood samples from me. These samples will be used to perform specific standardized laboratory procedures to determine levels of certain chemicals and substances in my body.
This test is being performed at my request. I understand that my blood sample will be collected at the Health Fair on April 27 between 8:00am and 11:00am at Grants High School Gymnasium. My results will be sent to my Primary Care Provider, if I list one below, and the results will be mailed to me and become a part of the legal medical record at Cibola General Hospital.