CONSENT FOR OBTAINING,
RETAINING, OR DISCLOSING
GENETIC INFORMATION
Page 1 of 2
As used in this document, “genetic information” means any information that is obtained from a genetic test.
1. I understand that no insurer or corporation that provides health insurance, carrier serving
small employers or health maintenance organization may:
(a) Require me or any member of my family to take a genetic test;
(b) Require me to disclose whether I or any member of my family has taken a genetic test;
(c) Request my genetic information or the genetic information of a family member of my family; or
(d) Determine the rates of any other aspect of the coverage or benefi ts for health care for me or my family based on whether I or any
other member of my family has taken a genetic test or based on my genetic information or the genetic information of any member
of my family.
2. I also understand that:
(a) I have the right to receive the results of a genetic test, after the person conducting the test has received the results. The written
results must indicate that, except as otherwise provided in chapter 629 of NRS, my genetic information may not be obtained,
retained or disclosed without fi rst obtaining my informed consent.
(b) It is unlawful for a person or entity to obtain genetic information without my informed consent, unless the information is obtained;
(i) By a federal, state, county or city law enforcement agency to establish the identity of a person or a dead human body;
(ii) To determine the parentage or identity of a person in certain circumstances;
(iii) To determine the paternity of a person in certain circumstances;
(iv) For use in a study where the identities of the persons from whom the genetic information is obtained are not disclosed to
the person conducting the study;
(v) To determine the presence of certain inheritable disorders in an infant in certain circumstances; or
(vi) Pursuant to an order of a court or competent jurisdiction.
(c) It is unlawful for a person to retain genetic information that identifi es me fi rst obtaining my informed consent, unless retention of
the genetic information is:
(i) Necessary to conduct a criminal investigation concerning the death of a person or a criminal or juvenile proceeding;
(ii) Authorized pursuant to an order of a court of competent jurisdiction; or
(iii) Necessary for certain medical facilities to maintain my medical records.
(d) If I have authorized a person to retain my genetic information, I may request that the person destroys the genetic information. Such
a person shall destroy the information, unless retention of the information is:
(i) Necessary to conduct a criminal investigation, an investigation concerning the death of a person or a criminal or a juvenile
proceeding;
(ii) Authorized by an order of a court of competent jurisdiction;
(iii) Necessary for certain medical facilities to maintain my medical records; or
(iv) Authorized or required by law.
Southwest Location: 5761 S. Ft. Apache • Las Vegas, Nevada 89148
Summerlin Location: 10105 Banburry Cross, #430 • Las Vegas, Nevada 89144
Green Valley Location: 3001 Horizon Ridge Parkway • Henderson, Nevada 89052
Phone: (702) 341-6610 • Fax: (702) 341-6961 • www.DesertPerinatalAssociates.com
