The following text is the contents of the Authorization Form that I signed with I signed up. It was presented to me in a web page, and once I agreed, a PDF of it was made available to me via a Drive link. Although the file is not in my Google Drive, I do not know if the link/document is unique to me, so instead of providing the link, I have copied the text. I did my best effort to reproduce the formatting: Wherever you see italicized text, that appears bold in the Authorization Form.

COVID-19 PUBLIC HEALTH PROGRAM AUTHORIZATION FORM

Background

Public health and healthcare professionals are responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in more than 100 locations internationally, including in the United States. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).

Current diagnosis efforts of COVID-19 are primarily focused on symptomatic and/or high risk individuals.

Verily, the Alphabet company focused on life sciences and healthcare, has offered to support public health efforts by providing its data collection infrastructure to help individuals understand their risk profile for COVID-19, help facilitate testing if indicated, and provide test results back to tested individuals in an efficient manner.

What will I need to do?

1) Complete a short survey.

This will include questions about yourself, including age, gender, home address, contact information, recent travel history, current health status, and any known contact with others who may have been exposed to SARS-CoV-2.

2) For those deemed eligible for free testing with this program, schedule an appointment to go to a local facility to provide a test specimen.

Based on your survey results, if you are identified as eligible for testing under this program for COVID-19 disease, you will be asked to provide a biospecimen using a nasopharyngeal (NP) swab.

• You will be asked to schedule an appointment at a local facility. You may be contacted directly to schedule this appointment or this may be facilitated through an app or web portal.

3) Go to the test facility at your assigned time for the test swab.

At the test facility, you will need to bring a form of identification to confirm your identity prior to performing the swab collection.

A trained healthcare professional will perform the swab collection.

• This will be done by having you tilt your head back while a trained healthcare member inserts a sterile cotton swab into your nostril towards the back of your nose. The swab will be inserted to a depth about the distance from your outer nose to the outer opening of the ear. Once inserted, it will be held in place for a few seconds then slowly removed with mild rotation. This may cause temporary discomfort.

• Your sample will be coded and associated with the data you provided in your survey.

Your sample will be tested by a clinical laboratory to determine if your sample is either positive or negative for SARS-CoV2.

4) Follow recommended guidelines based on results of your lab testing.

The lab results will be provided directly to you via email, text, phone call or through an app or web portal. The testing may take a few days and results will be returned to you when available.

In addition, results of your test will be provided to public health authorities, including the California Department of Public Health and potentially other federal, state, and local health authorities.

How will my data be protected?

Privacy is a top priority.

• Your data will be kept in a secure, encrypted database with restricted, monitored access

• This database complies with applicable state and federal laws that protect the privacy and security of your health information

Who will access my data and in what form?

Verily will have access to information that directly identifies you, including your name, street address, email address, and phone number. This information may also be provided to Verily’s contractors, the healthcare professionals who collect your specimen, the clinical laboratory that processes your specimen, he California Department of Public Health and potentially other federal, state, and local health authorities, and other entities that assist with the testing program. The information collected will be sed to perform the test, administer and improve the testing program, and for public health purposes.

In addition, your survey responses and test results will be provided to Verily, and may be further shared with the clinical laboratory performing the testing (for example, Quest Diagnostics), and public health authorities, including the California Department of Public Health. Public health officials may use this information to inform public health actions to help protect our community. Verily will not use your data for research purposes without your permission. In the future, you may be invited to share data collected during this process for research purposes.

Verily leverages certain technology and services from Google, including cloud services, security services, data storage, website hosting, and other support functions. Google’s access to data is strictly limited to the purpose of providing such services. Your data collected by Verily through the services described in this permission form will never be joined with your data stored in Google products without your explicit permission.

Does it cost me anything?

This survey and lab test will be provided at no cost to you.