INFORMED CONSENT – CONSUMERS
Please read this document carefully and sign below if you consent to SRx Health Solutions' pharmacogenetics services. Before signing this document, you may wish to speak with an SRx Pharmacist or other healthcare professionals about SRx Health Solutions' pharmacogenetics services and the benefits, limitations, and risks of the services.
SRx Health Solutions Precision Medicine/Pharmacogenetics Services:
- SRx Health Solutions’ pharmacogenetics services will assess your genetics profile for factors that influence your response to medications.
- SRx Health Solutions’ pharmacogenetics services generate actionable personalized reports that may provide insight for your health care provider(s) about how you process or respond to certain medications.
- SRx Health Solutions’ pharmacogenetics services have carefully selected the gene variation + medication combinations which have strong scientific evidence and which potentially have important clinical value.
Condition of Services and Limitations:
- Incorrect collection technique may result in insufficient samples or other contaminations which may affect the accuracy of my sample analysis and results.
- The SRx Health Solutions pharmacogenetics services are not for diagnostic purposes and do not replace the role of a healthcare provider.
- The results of SRx Health Solutions’ pharmacogenetics services are not intended to be self-interpreted as individuals may misunderstand and/or misinterpret the results.
- A doctor, pharmacist, and nurse practitioner should always be consulted before changing any medications or treatment plans.
- SRx Health Solutions’ pharmacogenetics services may not detect every variant that may affect certain medications. SRx laboratories have implemented safeguards to prevent technical errors, but false positive and false negative results may occur.
- A “normal metabolizer” result indicates that the tested non-normal alleles were not present. It does not guarantee that the gene functions normally.
- Not all medications are included in the results report.
- Information about genetic variations and medication response is evolving and changing and not all relationships are detected.
- SRx Health Solutions pharmacogenetics services must be considered as one tool along with numerous other influences that may be used to optimize your medication. Results are based on the best current medical knowledge and SRx laboratories do not undertake to update results after they have been provided if the best medical knowledge changes. There may be other limitations or risks that are currently unforeseen.
Privacy Acknowledgement:
- Once the test is completed, no additional clinical testing will be performed on the sample and any remaining DNA will be destroyed.
- Test results and personal information will be shared with third parties identified and directed by the client throughout the purchasing, testing and results processes and/or as required to effect the pharmacogenetic services and in accordance with applicable privacy legislation.
- SRx Health Solutions’ privacy practices are outlined in our privacy policy, available online at www.srxhealth.ca
- All genetic data will be processed and handled in accordance with applicable legislation.
In signing below, I confirm that:
- I have read this document.
- I have had the opportunity to seek consultation from a pharmacist or other healthcare provider or chosen not to do so.
- I have followed the instructions provided in my kit for the collection of my sample to the best of my abilities.
