ResourcePath laboratory is asking students, family members and teachers/staff who want to participate in sentinel surveillance testing to sign a consent and fill out an intake form. For children under 18, we request that a parent/guardian fill out consents and intake forms (one for each child).  All information is protected under HIPAA. All surveillance testing is free with no out of pocket charges and no billing of insurance.  

Use the links on the right to access the Consent and Intake Form in your preferred language.  If you have any special needs or do not have access to a computer or smart phone, please call our lab at 571-375-0755 and we will assist enrolling you/your child in the program.  

After completing the Intake Form and the Consent Form, with signatures, the forms can be submitted electronically by clicking the “Submit” button.  If you have any questions, concerns or suggestions for improvement, please call the laboratory at 571-375-0755 or email us at info@resourcepath.net.

If you have any suggestions on how to make our instructions or forms easier to complete, please let us know!  Our Medical Director is an APS Parent and we are happy to accept help from APS parents for this community project. 

Detailed Instructions on how to fill out the consent and intake forms. 

Parents or guardians will complete forms for students under 18.  Teachers and staff will complete their own forms.  It is important to note that a consent and intake MUST be completed for EACH person being enrolled in the program, i.e. if you have two children, you will fill out one form for each child (two forms total).   To access the forms, click one of the links on the right hand side of the page. 

Upon opening the link, you will be asked to enter a name and email address.  If you don’t have an email address, you can enter your mobile phone number.  If you do not have either an email address or mobile phone, please reach out to your school for paper forms and we will make sure that we can help you access the testing.

The next screen requires parents or guardians to input their name as the person completing the form on behalf of the student. The email provided will be the one used to receive the test results.

The APS testing consent is located at the top of the form for review and signature. 

The Consent Form will ask you to give the laboratory permission to 

    1. Provide the test to you or your child 
    2. Release the results of testing to you by secure email, and
    3. Release the results of testing to school public health in order to assist with contact tracing 

Please be sure to open this form, review and click the box that allows you to electronically sign the Consent Form.  If you would like to receive reports in “unencrypted” form, please check the box at the bottom of the consent.

Complete the demographic information in the intake form for your child.  You may use the parental email and phone to fill in those boxes respectively. 

We have boxes for families to include insurance information in this intake form.   For those without insurance, the Social Security Number of the person being tested, if available, can be used by ResourcePath to request reimbursement for the test from HRSA, a governmental source of payment.  We will not bill insurance for surveillance testing; however we collect this information in the case of future need of PCR testing for symptoms or exposure so that information does not need to be completed more than once.  You can elect to not include that information at this time if you wish. 

After completing the Intake Form and the Consent Form, with signatures, the forms can be submitted electronically by clicking the “Submit” button.  If you have any questions, concerns or suggestions for improvement, please call the laboratory at 571-375-0755 or email us at info@resourcepath.net.

Special thanks to APS Parent Adon Hwang for the helpful suggestions, screenshots and annotations!