• COVID-19 Rapid Antigen Test Request Form

    COVID-19 Rapid Antigen Test Request Form

    Corporate Group Members
  • Is this your place of employment?*

  • I. Demographic Information

    Please complete the required demographic information as per The Bahamas Ministry of Health Guidelines.
  • Gender*
  • Date of Birth*
     / /
    2 digit day, 2 digit month, 4 digit year

  • Format: (000) 000-0000.
  • II. Health-related Screening Questions

    II. Health-related Screening Questions

    Please complete the required health and surveillance information as per The Bahamas Ministry of Health Guidelines.
  • 1. Have you tested RT-PCR positive for COVID-19 in the last 14 days?*
  • 2. Have you had contact with a person who confirmed testing positive for COVID-19, or is suspected to have COVID-19, in the last 14 days?*
  • 3. Do you have any of the following symptoms? - Fever, Cough, Shortness of Breath, Headache, Loss of taste or smell, Chills, Muscle Pain, Sore Throat*
  • 4. Have you travelled within the last 14 days?*
  • 5. Vaccination Status*
  • Date of Last Dose*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Please indicate your symptoms below: *
    Rows
  • Date of Symptom Onset*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Arrival/Return Date to The Bahamas*
     / /
    2 digit day, 2 digit month, 4 digit year

  • DISCLAIMER

    The RD-Ag (Rapid Antigen) test performed is used for screening purposes only and is not validated for the definitive diagnosis for SARS-COV-2 (COVID-19) in a comparable fashion as a real-time polymerase chain reaction (RT-PCR)-test. The screening reports you will be provided are not RT-PCR COVID19 test results.

    RD-Ag tests are most likely to perform well in patients with high viral loads (Ct values ≤25 or >106 genomic virus copies/mL) which usually appear in the pre-symptomatic (1-3 days before symptom onset) and early symptomatic phases of the illness (within the first 5-7 days). A negative result does not preclude SARS-CoV-2 infection and should not be used as the sole basis for patient management and workplace planning decisions. When diagnostic testing is negative, the possibility of a false negative result should be considered in the context of a patient's recent exposures and the presence of clinical signs and symptoms consistent with COVID-19. 

    The Clinical recommendation for positive results in RD-Ag testing is to follow-up with RT-PCR testing for confirmatory diagnosis. If your Rapid Ag Test results as Positive for COVID-19, The Government of The Bahamas requires such confirmatory testing.


    CONSENT

    By registering for testing, you consent to being tested by Doctors Hospital (Bahamas) Limited, its employees and or agents, and to your test result(s) (and any and all information submitted herein) being retained by and shared by and among Doctors Hospital (Bahamas) Limited and The Government of The Bahamas.  

     
    LIABILITY WAIVER, RELEASE & INDEMNITY
    In consideration of being permitted to complete this registration process, and of being tested, you, for yourself, your heirs, personal representatives or assigns, do hereby release, waive, discharge and covenant not to sue Doctors Hospital (Bahamas) Limited, its employees and or agents and to hold them harmless and indemnify them from liability and from any and all claims, including those involving personal injury, accidents, or illness (including death) arising from your participation in this registration process and the testing which follows.  

     
    GOVERNING LAW

    All terms and conditions herein, shall be construed in accordance with and governed by the laws of the Commonwealth of The Bahamas.  Any dispute in relation thereto, or to this registration process, or the testing which follows, shall be subject to the exclusive jurisdiction of the Courts of the said Commonwealth.

  • Date
     / /
    2 digit day, 2 digit month, 4 digit year
  • 5. Vaccination Status*
  • Should be Empty: