Statement of Informed Consent and Release [知情同意及免責聲明]

I/We acknowledge and confirm that I/we have read and understood the informational material that has been provided about the Service by my/our Healthcare Professional, and have been given the full opportunity to discuss Metascreen™ with my/our Healthcare Professional and make an informed decision to obtain Metascreen™.

I/We hereby consent to the performance of the Service by HKSC for my/our Child and the transmission of the urine sample and results by Cordlife to and from HKSC. I/We further understand and agree that the fees for the Service shall not be refundable in the event that the Service could not be performed in view of my/our failure to properly collect the urine sample or transmit the same to Cordlife for any reason whatsoever.

I/We have been informed that the analyses, conducted as part of the Service, produce results that can be used by qualified physicians in the diagnosis of disorders described in www.Metascreen.org. I/We understand that the evidence of these conditions will be detected in the majority of affected individuals; however due to the age of the Child at time of collection of the Specimen, the quality of the Specimen, health status of the Child and other variables, such conditions may not be detected in my Child. I/We hereby release and hold free and harmless Cordlife, HKSC, my/our Healthcare Professional, the hospital or birthing center, and all their respective officers, directors, employees, agents, affiliates, successors and assigns from any and all liability for any and all loss, harm, damage or claim of any kind in connection with the collection, processing, testing, screening and transport of the Specimen and its results. In all other cases, I/we understand that the liability of Cordlife, HKSC, my/our Healthcare Professional, the hospital or birthing center, and all their officers, directors, employees, agents, affiliates, successors and assigns to me/us shall not exceed the amount of fees I/we have paid.

I/We further acknowledge and consent to a portion of the Specimen being used anonymously for research purposes and the findings thereof being used in research publications in compliance with all relevant laws and ethical guidelines. I/We further waive whatever rights, claims or interests which I/we may have over the Specimen of the Child, in full and complete support of the research.


本人/我們確認已細閱及明白本人/我們的專業醫護人員向本人/我們提供的資料,亦有全面機會與本人/我們的專業醫護人員討論及並作出明智的決定選擇Metascreen™(安康檢)服務。

本人/我們特此同意香港篩檢履行此服務予本人/我們的孩子,並透過康盛運送其尿液樣本至香港篩檢及送回測試結果。本人/我們進一步明白及同意如因任何原因以致本人/我們未能妥善收集尿液樣本或運送此樣本到本公司,此服務費用將不獲退回。

本人/我們亦已被告知,合資格醫生可使用由此服務的一部分所分析的結果,對www.Metascreen.org所述的疾病作診斷之用。本人/我們明白此類情況的徵兆雖於大部份受影響的人都被會檢測到,但由於在收集年幼小孩樣本的時間、樣本的質量、小孩的健康狀況等變數,亦有可能出現檢測不到的情況。本人/我們特此免除康盛、香港篩檢、本人/我們的專業醫護人員、醫院或分娩中心,和他們所有的董事,僱員,代理人,關聯公司,繼承人及受托人任何有關收集、處理、檢測、篩查和運送樣本及其測試報告所之任何及所有責任分配所產生的所有損失,損害,損壞或索償。在所有其他情況下,本人/我們明白康盛、香港篩檢、本人/我們的專業醫護人員、醫院或分娩中心和他們所有的董事,僱員,代理人,關聯公司,繼承人的責任及分配,將限於本人/我們已繳交的金額總數。

本人/我們進一步確認和同意有部分樣本會被匿名地用於研究目的,作為符合所有相關法律及道德準則部分的出版物之用。本人/我們亦支持研究並放棄任何涉及孩子樣本權利,申索或利益。


(This Registration Form, Personal Information Collection Statement, Statement of Informed Consent and Release shall be written in English and may be translated to other languages. In any event of any discrepancy between the English and translated version, the English version shall prevail.)

(本登記表格, 收集個人資料聲明, 知情同意及免責聲明由英文制訂並可供翻譯至其他語言。若本免除責任書之英文版本及其翻譯版本有所出入,將以英文版本為準。)