Patient Consent For Molecular Profiling

About Molecular Profiling

Comprehensive molecular profiling from Caris Life Sciences® (Caris) assesses the biomarkers found in your tumor, revealing a molecular blueprint to help your doctor make more informed and individualized treatment decisions specific to your cancer. After testing is completed and the report has been provided to your treating physician, your blood specimen will be destroyed within 60 days. You can learn more about how Caris uses and protects your data by visiting www.CarisLifeSciences.com/privacy-us.

About Genetic Testing 

Molecular profiling from Caris may also include genetic (germline/hereditary) testing for cancer, which can provide information about your risk of inheriting other types of cancer or other health problems. Depending on your testing results, you or your family members may be referred to another provider for additional testing and/or genetic counseling. There are federal and state laws that provide some protections against genetic discrimination by employers and health insurers, but these laws do not apply in all situations. You can visit www.genome.gov/10002328 for information about the Genetic Information Nondiscrimination Act, a federal law that protects genetic information.

Limitations of Genetic Testing 

Genetic tests cannot detect all genetic mutations and all carriers of a condition. It is possible that you are a carrier of an uncommon genetic mutation that cannot be detected by this test. Germline variants of unknown clinical significance (VUS) are not reported unless specifically requested.

Patient Consent

By signing below, I agree to the following:

I authorize Caris to perform testing of my specimen to support my physician in the treatment of my cancer, or the patient for whom I am legally authorized to consent. 

I understand the information provided in this consent form, I have been advised about the availability and importance of genetic counseling, and I am aware that I can contact Caris if I have additional questions. 

I received information about this test and discussed it with my treating provider, including its purposes, the reliability of test result and the level of certainty that the result may serve as a predictor of a disease or condition. I have had an opportunity to ask questions and my questions have been answered. 

I understand that I may learn that I may be a carrier for a hereditary condition or be predisposed to or have another type of cancer, and that I may wish to consider further independent testing for myself and/or my family members. 

I authorize Caris to act on my behalf regarding the determination, denial and/or any necessary appeal relating to coverage of laboratory services provided by Caris, as well as authorize Caris and third-party Payors to release any of my protected health information (PHI) for the purpose of resolving my claim and/or appeal.