Your health care provider has or will order one or more tests offered by Tempus (the “Tests”). The Test reports do not provide a definitive medical diagnosis or make any specific treatment recommendations; instead they provide information for your healthcare provider to review. There is no guarantee that performance of a Test will yield clinically relevant information, inform your health care provider’s clinical decision-making, or otherwise lead to any particular or beneficial outcome for you. Some test results may show one or more “actionable” genomic alterations, meaning that there may be FDA-approved therapies available that target a specific disease subtype, certain clinical trials may be available to you, or genetic information that may impact your ongoing health care management. Knowledge about these facts and the meaning of genetic changes is constantly changing. The Tests do not examine every possible genetic variant that may exist, and the Tests also may not identify all variants related to you or your disease, because there is a possibility of testing errors and because some biological factors may limit the accuracy of results. Tempus is not obligated to update, revisit or later re-evaluate the results of the Tests after those results have been made available to your healthcare provider. Test results may reveal certain personal health information about you or information about your genetic profile that is unrelated to your current diagnosis, if you have one, such as hereditary information or additional diagnoses (“incidental findings”). If incidental findings are reported, you may learn medical information about yourself or your family that you did not expect. You may want to discuss this information with your doctor or a genetic counselor. If you want to talk to a genetic counselor, you can ask your doctor to refer you to one, or you can find contact information on the Test report that Tempus will make available to you or your healthcare provider.
You authorize release of pathology tissue samples, blood, saliva, cheek swab samples, and other materials, including extracted DNA and RNA, requested by Tempus (“Materials”) to conduct the Tests, and direct the applicable pathology lab to release all such Materials to Tempus. For genetic Tests that require Materials, genetic Material including DNA and/or RNA will be obtained, stored, and analyzed, by Tempus and/or a reference lab. You understand that the Materials may be irreplaceable and could be lost or damaged in handling, transit or when used. You agree to release Tempus, and any pathology laboratory releasing such Materials, from any claims for any such loss or damage to the Materials. The Tests will generate health data about you and Tempus or the reference lab may receive health data from your medical record in connection with the Tests. Your identifiable data is subject to legal requirements regarding its use and protection. Tempus may use and disclose the Test results and your other health data as described in its notice of privacy practices (NPP). Tempus’ current NPP, which includes information about how de-identified DNA analysis and other health data may be commercially used and shared in or out of the United States with life science companies or others, is at www. tempus.com/notice-of-privacy-practices/.
Leftover Materials may be retained indefinitely and used and shared for quality, test validation, and other purposes described in the NPP, some of which may involve DNA or RNA analysis. Third parties receiving de-identified data or Materials are prohibited from using it to re-identify you.
Unless you self-pay for the Tests, you assign all health insurance benefits and reimbursement under your health plan(s) to Tempus for ordered Tests, and appoint Tempus as your authorized representative and convey to Tempus, to the full extent permissible under the law, the power to file medical claims, appeals, and grievances with the health plan and/or any agency or governmental body with applicable authority; obtain and release medical records and insurance information as necessary to process a claim, appeal or grievance; and collect payment of any and all medical benefits and insurance proceeds (including Medicare and Medicaid). The appointment and conveyance includes all of your rights in connection with any claim, right, or cause of action including litigation against your health plan that you may have, including, the right to claim on your behalf, all such benefits, claims, or reimbursement, and to seek fines or other applicable remedy.