RequiredPatient Consent Form
Privacy Notice
Exact Sciences Laboratories, LLC, its direct and indirect subsidiaries and affiliates, its vendors and contractors ("Exact Sciences," "we," "us," or "our") and accredited laboratory partners will process Personal Data, including Health Data, as it is defined within the applicable jurisdiction in accordance with applicable law (hereinafter "Personal Data").
To perform our services, we will process your Personal Data in countries other than the jurisdiction in which you reside. When we transfer your Personal Data outside your jurisdiction, we will take steps to ensure that such transfers have appropriate security measures, are stored in accordance with applicable data retention requirements, and comply with applicable law, including implementing measures such as standard data protection clauses or relying on other legally approved transfer mechanisms.
Undertaking the Cancerguard Test is voluntary, and you may withdraw your consent to the processing of the test including your Personal Data at any time by advising Exact Sciences using the contact details provided below; however, withdrawal of consent may affect our ability to complete testing or provide related services depending on when the withdrawal is received and what processing is required by law. We will communicate with you about the status of the Cancerguard Test, including via email or by consenting to receive SMS/text messages. The withdrawal of consent does not apply to processing that has occurred prior to such withdrawal. If the test has been ordered and consent later withdrawn, you will be invoiced for the test in full and liable for payment.
You may have certain rights, under applicable law, regarding the Personal Data we hold about you. These may include the right to access, correct, delete, restrict or object to our use of, or receive a copy of your Personal Data. You may execute such rights by contacting Exact Sciences using the contact details provided below.
You understand that you are responsible for costs and billing charges not covered by your health insurer or sponsor and that coverage is not guaranteed. Exact Sciences may appeal adverse benefit determinations on your behalf.
Contact Us
Visit the Exact Sciences Privacy and Trust Center (https://www.exactsciences.com/privacy-trust) to learn more about our privacy practices. The Privacy Policy section titled "How to Submit a Request" includes information on how to request rights regarding your Personal Data.
Scroll to the end of the Privacy Notice to continue.
Patient consent
I hereby consent and authorize, to the extent required by law, Exact Sciences to take my blood sample, perform and process the Cancerguard Test, and process my Personal Data as necessary for the performance of the Cancerguard Test, including: laboratory testing by Exact Sciences and accredited laboratory partners; healthcare operations necessary to support the Cancerguard Test (including quality verification, audit, compliance, safety, and accreditation); invoicing and payment activities (including insurance claims, appeals, and collections, where applicable); communicating with the physician or healthcare professional who ordered my Cancerguard Test; and responding to questions I may have about the Cancerguard Test and communicating my Cancerguard Test results to me or my Substitute Consent Giver, including coordinating appropriate follow-up where indicated.
I have read and understand the Privacy Notice/Patient Consent and I consent to the transfer and processing of my Personal Data as described in this Patient Consent and the Privacy Notice.
Important information
I understand that if my result is positive, next steps to help confirm and locate a possible cancer may include imaging tests, such as a CT scan with IV contrast. These tests may involve exposure to radiation and carry other standard risks associated with medical imaging.
By signing and selecting your consent preferences, you acknowledge you have read and understood this Patient Consent Form and the rights it describes regarding your Personal Data and provide your consent choices.