HIPPA-FERPA Authorization Fillable Form
Demographic and Insurance Fillable Document
Dear University School Community,
ETSU would like to announce to the University School family that COVID-19 surveillance testing is now available for all of our students. The testing is being performed through a partnership with ETSU Health that provides results typically within a 24-hour period.
Those interested in opting in to this testing program will need to complete the attached documents, which include a new consent form completed for all of our participants, a HIPPA and FERPA authorization form giving permission for the results to be directly shared with the school in addition to the families, and a demographics and insurance form. Although there will be no direct cost for families, the provider is required to file a claim with each of our participants insurance providers, so we ask that in addition to demographic form you also send a photo copy of the front and back of your insurance cards. These forms can be submitted through this secure Dropbox link or you may submit them directly to our school nurse.
To encourage participation and to acknowledge the time this will require, all participants who opt-in for COVID-19 surveillance testing will receive a University School t-shirt. Additionally, your name will be entered into regular drawings to earn gift cards to local restaurants, grocery stores, etc.
Remember, this does not replace testing requirements for a student who is sick or otherwise exposed to COVID-19. If a student exhibits COVID-19 symptoms, or they become aware of being exposed to someone with COVID-19, the student should remain home, seek medical care as needed, and follow the instructions outlined in the Tennessee Department of Health Return to School Algorithm document.
Thank you for being a valued member of the University School community.