Skin Prick Testing Consent

Purpose:
The diagnosis of allergies involves a procedure known as skin prick testing. Interpreting the clinical significance of skin tests requires skillful correlation of the test results with the patient’s clinical history. Positive tests may indicate the presence of allergic antibodies that correlate with clinical symptoms.

Skin Prick Testing Procedure:

This test exposes you to tiny amounts of allergens via scratches that penetrate only the very top layer of skin. You may feel only a slight prick of the skin. These tests are typically placed on the arm or back. Local reactions may be seen within 15-20 minutes. These reactions include a small welt, redness, itching and/or burning and gradually disappear over a period of 30 to 60 minutes, and, typically, no treatment is necessary for these reactions. The Provider or Nursing Team Member will examine any site reactions.

Adverse Reactions:

Occasionally local reactions at a test site may last longer. These reactions are not serious and will disappear over the next week or so. They should be measured and reported to your physician at your next visit.

There is a rare potential for anaphylaxis, a life-threatening reaction which may include swelling, sneezing, runny nose, watery eyes, shortness of breath, chest tightness, wheezing, lightheadedness, drop in blood pressure and shock. Please note that reactions rarely occur but in the event a reaction would occur, the staff is fully trained and emergency equipment is available.

Our Financial Policy:

We will submit claims for Skin Prick Testing to your insurance company. A Financial Agreement must be signed prior to testing. You may speak with our front office staff for more information.

Consent:

I have read and understand the information on this skin prick testing consent form.

The opportunity has been provided for me to ask questions regarding the potential risks of proceeding with skin prick testing. My questions have been answered to my satisfaction. I understand that precautions consistent with the best medical practice will be carried out to protect me from adverse reactions. I do hereby give Monarch Allergy Medical Services of New York, P.C. and Monarch Allergy Medical Services of Florida, P.A. (collectively, “Nectar Allergy Center”) consent to proceed with skin prick testing. I further hereby give authorization and consent for treatment of any reactions that may occur. I understand that epinephrine, antihistamine, and other medically reasonable medications may be given to me in the event of an adverse reaction.