COVID Testing Schedule

8:00 AM – 5:30 PM1/9/2021 - 1/10/2021

Poplar Healthcare

8:00 AM – 5:30 PM1/23/2021 - 1/24/2021

Poplar Healthcare

Location Information

  • Poplar Healthcare
  • 3495 Hacks Cross Rd, Memphis, TN, 38125

    By signing this Authorization, I hereby direct the use or disclosure by the following named laboratory providing COVID-19 testing: Poplar Healthcare, of certain protected health information (PHI) pertaining to the patient listed above. This Authorization concerns the following information about the patient:

    Name, address and results of testing for exposure to the COVID-19 virus

    This information may be used or disclosed by the above-named laboratory and may be disclosed to:

    Dr. Manoj K. Jain
    City of Memphis designee (as needed, to assist with contact tracing)

    I understand that I have the right to revoke this Authorization at any time, except to the extent that the above-named laboratory has already acted in reliance on the Authorization. To revoke this Authorization, I understand that I must do so by written request to the above-named laboratory:

    Poplar Healthcare:
    3495 Hacks Cross Road,
    Memphis, TN 38125
    ATTN: Joe Davis, Compliance Officer

    I understand that information used or disclosed pursuant to this Authorization may be subject to redisclosure by the recipient and no longer subject to privacy protections provided by law.

    I understand that my written authorization is not required for the above-named laboratory to use my protected health information for treatment, payment and healthcare operations.

    I understand that I have the right to inspect and copy the information that is to be used or disclosed as part of this Authorization. The Authorization is being requested by Poplar Healthcare for the following purpose(s):

    Management and control of the COVID-19 pandemic within the City of Memphis and Shelby County, Tennessee.

    The use or disclosure of the requested information will result in direct or indirect remuneration to the above-named laboratories from a third party.

    I acknowledge that I have read the provisions in the Authorization and that I have the right to refuse to sign this Authorization. I understand and agree to its terms.

    This authorization expires on: Completion of the COVID-19 testing program within the City of Memphis.

    I, the undersigned, give permission for contractors hired by the City of Memphis to perform PCR nasal swab tests on me/my child to check for infection with the COVID-19 virus. I understand that the nasal swab tests will be performed by contractors trained to perform the tests properly in accordance with standard medical and laboratory procedures, and that the tests will be transported to a laboratory qualified to process the tests and provide results in a timely manner. I further understand that I/my child may be required to avoid attending work/school for at least a ten- to fourteen- (10-14)- day period in the event of a positive test result; and that in the event I/my child have been in contact with another coworker/student who has tested positive for the COVID-19 virus, I/my child may be isolated or sequestered, along with any other coworker/student likewise exposed, separately from other coworkers/ students at work/school, for up to a ten- to fourteen- (10-14)- day period, or as otherwise required by the Shelby County Health Department, even if I/my child have not tested positive for the COVID-19 virus.
    I agree and acknowledge that the City of Memphis, its employees, associates, volunteers, personnel and/or contractors will have no liability whatsoever for any claims, damages, demands, judgments and loss including but not limited to illness, injury, and/or death, arising from or otherwise connected with the City of Memphis’ and/or its contractors’ testing of me/my child for infection with the COVID-19 virus and/or subsequent actions taken by work/school in response to my/my child’s test results or the test results of any coworker/student with whom I/my child have been in contact.

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