It is up to the emergency department to determine the protocol for implementing opt-out screening that best fits the local context, with Technical Assistance from CDPH and PHI/Bridge, as needed. Opt-out testing is when a patient is notified that testing will be performed unless they “opt out” of (decline) testing. Separate written consent is not required for HIV testing. If they do not refuse the test, then the test can be performed. The HIV testing requirements are outlined in the California Health and Safety Code § 120990.

For patients who are not competent, if you can justify it clinically, for example altered mental status may be due to neurosyphilis or opportunistic infections such as cryptococcus meningitis, then it is reasonable to test these individuals unless they refuse (opt-out of) testing.

A sample opt-out screening script is: “Our emergency room screens all individuals getting a blood draw for syphilis, HIV, and Hepatitis C. Please let us know if you do not want any of these tests today.”

Implementation plans may include universal screening for all ED patients; screening all patients who receive a blood draw in the ED, screening high-risk individuals, or other novel approaches to routine screening.

Routine opt-out is not “all or none.” Patients retain the right to opt out of any and/or all tests.