COVID-19 is caused by the SARS-CoV-2 virus. Infection with the virus can range from being asymptomatic to life-threatening respiratory illness. Infection has been detected globally and in all 50 states. Symptoms associated with COVID- 19 include cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, headache, sore throat or new loss of taste or smell. COVID-19 can present with severe illness in individuals of any age and without any previous health problems, but the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Having underlying medical conditions may also increase one’s risk for severe illness from COVID-19. Conditions and other risk factors that may be associated with severe illness and death are listed below.

If you have any symptoms for COVID-19 and any of the following conditions or risk factors, which may put you at increased risk of severe illness from COVID-19, you should consult with your healthcare provider before using this test:

• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Immunocompromised state (weakened immune system) from solid organ transplant or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
• Obesity (body mass index [BMI] of 30 or higher)
• Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
• Sickle cell disease
• Type 2 diabetes mellitus
• Asthma (moderate-to-severe)
• Cerebrovascular disease (affects blood vessels and blood supply to the brain)
• Cystic fibrosis
• Hypertension or high blood pressure
• Neurologic conditions, such as dementia
• Liver disease
• Pregnancy
• Pulmonary fibrosis (having damaged or scarred lung tissues)
• Smoking
• Thalassemia (a type of blood disorder)
• Type 1 diabetes mellitus
• Children who are medically complex, who have neurologic, genetic, metabolic conditions, or who have congenital heart disease

Regardless of your risk status, if you are experiencing any of the following emergency warning signs for COVID-19, it is recommended that you immediately seek emergency care:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake up or stay awake
• Bluish lips or face

No, I am not experiencing any symptoms

Yes, any of the following

• Flu-like symptoms (chills, runny or stuffy nose, whole body aches, a headache, and/or feeling tired)?
• A fever between 100.4°F and 102.0°F?
• A new loss of taste or smell?
• A new or worsening cough or sore throat?
• Shortness of breath that is not limiting ability to speak?
• Fatigue, muscle aches, body aches, or headache?
• Congestion or runny nose?
• Nausea, vomiting, or diarrhea?

Redirecting you…

Been exposed to COVID-19 through living or working in a place where people reside, meet, or gather in close proximity (office buildings, schools, healthcare facilities, etc.)?

Had close contact (within 6 feet) with someone who is sick or diagnosed with COVID-19?

Had strong emotions and overwhelming anxiety about the possibility of potentially being infected since the COVID-19 outbreak?

None of these apply to me.

Because you have an upcoming medical procedure.

Are required to provide a COVID-19 test result to return to school.

Employer requires for back to work.

None of these apply to me.

Based on your answers to the questionnaire, you do not meet the eligibility requirements for COVID-19 testing. If you believe this is an error and would like to schedule anyway, please indicate the reason you are requesting this COVID-19 test in the space below and continue scheduling your test. Please describe your reason in detail.

PLEASE NOTE: If your insurance provider deems this reason medically unnecessary and does not cover the cost of this test, you will be responsible for any remaining balance.

HIPAA-
Ethos Laboratories (“Company” or “We”) respects your privacy and is committed to protecting it through our compliance with this policy as well as with all applicable laws, including the privacy and security rules and regulations of the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”) Specifically, We maintain reasonable administrative, technical and physical safeguards which are designed to ensure the confidentiality, integrity and availability of the personally identifiable health information that We maintain on our website and related information systems. However, no system is impenetrable and we cannot guarantee the confidentiality, integrity and availability of such personally identifiable health information.