Consent for HIV testing
Please read this before signing. You may ask questions, and you may decline.
Tests this consent covers
| Test | Sample |
|---|---|
| HIV 1 & 2 antibody (4th generation) | Serum |
Declaration
I confirm that the purpose of the test, the meaning of a reactive and a non-reactive result, and the confidentiality of my result have been explained to me in a language I understand. I consent to the collection of a blood sample for this test. I understand that I may withdraw this consent at any time before the sample is tested.
Patient / authorised signatoryName:
Relationship to patient:
Signature and date
Relationship to patient:
Signature and date
Explained byName:
Designation:
Signature and date
Designation:
Signature and date
WitnessName:
Signature and date
Signature and date
For laboratory staff — not part of the patient's declaration
Pre-test counselling is mandatory. Record the counsellor's name in the laboratory register; a reactive result is disclosed in person, never over the phone or by message.
Form Consent for HIV testing, version v2.1. NACO National HIV Testing Guidelines · ICMR ethical guidelines. Document SPECIMEN/CS/2026/0007. Retain the signed original with the laboratory record.