I hereby request that the laboratory, provider, or other entity holding all completed laboratory and diagnostic test results arising from services performed for me (the "Results") release those Results to me.
Where technically supported and expressly selected by me, I further authorise Centurion Lab partners to transmit those Results to me through Centurion, provided by THE BORING AI LTD, acting solely as my designated technical agent for the transmission, display, and/or local import of the Results on my device.
I hereby acknowledge and accept that:
(a) the Results may, in accordance with applicable law and ordinary laboratory or healthcare workflows, also be communicated to the prescribing, ordering, or otherwise responsible healthcare professional, if any;
(b) the release, transmission, display, storage, organisation, or summarisation of the Results through Centurion should not be viewed as medical advice and is not intended to replace direct communication with the ordering provider, the laboratory, or another qualified healthcare professional;
(c) all questions regarding the meaning, interpretation, reliability, limitations, or clinical significance of the Results should be directed to the laboratory that produced them, the ordering provider, or another qualified healthcare professional;
(d) Centurion does not order tests, perform laboratory analyses, validate laboratory results, interpret results medically, prescribe treatment, or provide any regulated healthcare service;
(e) unless and until I expressly enable an optional remote feature, my use of Centurion is intended to be local-first and on-device; if I choose to enable any optional remote feature, separate consents, settings, and policies may apply to any further processing of the Results;
(f) this request authorises release and technical transmission of the Results only. It does not authorise Centurion to exercise clinical judgment, give me a diagnosis or treatment, or act as my healthcare provider;
(g) I am requesting the Results for myself, or I am lawfully authorised to act for the person whose Results are requested; and
(h) I may withdraw this request before the Results are released by contacting the laboratory or provider directly, but any release or transmission already completed before withdrawal may continue to be relied on.
Patient / Requester Details
Full name: ______________________________
Date of birth: ______________________________
Address: ______________________________
Email: ______________________________
Phone: ______________________________
Laboratory / provider reference (if any): ______________________________
Centurion account email (if applicable): ______________________________
Date: ______________________________
Signature: ______________________________
Centurion contact: hello@centurionos.com
Entity: THE BORING AI LTD
Address: PROFILE WEST, SUITE 2 FIRST, 950 GREAT WEST ROAD, BRENTFORD, TW8 9ES