1. INTRODUCTION 1.1. The clinic where you are taking the test (the “Clinic”) has licensed QbCheck for use in its operations. QbCheck offers an objective method for measuring the three core signs of ADHD – hyperactivity, inattention and impulsivity – in children, adolescents and adults. The test system is used to support diagnosis and to show response to and progress of treatment. All evaluation and treatment will be carried out by qualified personnel. 1.2. The QbCheck is provided by Qbtech AB, Cardellgatan 1, 114 36 Stockholm, Sweden. The Clinic is data controller for information about you about you which is processed within the QbCheck and you will be provided with a separate data privacy notice from the Clinic covering their processing of your information about you in accordance with the Swedish Patient’s Data Act (Sw. patientdatalagen (2008:355)). Qbtech AB is a data processor and may only process such information according to the instructions of the Clinic apart from what is explicitly stated below in section 3. 1.3. Qbtech AB is the data controller for the processing of your information described in section 3 below, to the extent such information would constitute personal data. 2. GENERAL INFORMATION REGARDING QBCHECK 2.1. The software in QbCheck contains a form where the test administrator manually enters the following information concerning you as a test person: QbCheck patient ID (not your personal identity number), date of birth, length, weight, gender, diagnosis, details regarding medication, test results and other relevant notes. The information is processed in the software client and is submitted, at each test event, to a central server hosted by Amazon Web Services (AWS) in Ireland. The server generates test reports where test data and certain parameters are set out. The transfer of test data between the software client and the server is encrypted with a certificate. 2.2. All information that the test administrator manually enters into the software client, data from the test and the test report is centrally stored by AWS. The information is only available for authorised users within the Clinic and for authorised personnel and consultants of Qbtech AB and it’s subsidiaries to provide the QbCheck services to the Clinic under the Clinic's instructions. 2.3. No individual test data which can directly identify you will in any form be transferred or in any other manner be made available to third parties (except if required to fulfil legal requirements towards public authorities and the like) without first obtaining your prior written consent. 2.4. Under the instructions of the Clinic your QbCheck patient ID (not your personal identity number), date of birth, length, weight, gender, diagnosis, details regarding medication, test results and other relevant notes will upon your consent below be stored for five (5) years (measured since last activity). Your data will then be deleted by replacing your patient ID and ClinicID with new IDs which are randomly created by a computer. Once these ID-numbers are replaced, Qbtech cannot identify you since Qbtech has no access to information which can connect the new IDs to your QbCheck patient ID, Clinic or your name. 3. QBTECH'S PROCESSING OF YOUR INFORMATION 3.1. When the new randomized IDs are created and your data is no longer identifiable the test data will thereafter be used by Qbtech for the purpose of developing the QbCheck to gain further insight into diagnosis and treatment and for other commercial development. This will be of benefit both to you and other individuals performing the QbCheck. Note again that no information which can directly identify you is used. 4. YOUR RIGHTS AS A TEST PERSON 4.1. To the extent information constitutes personal data certain rights may apply under law as detailed in sections 4.2 to 4.9 below. 4.2. If you identify that any personal data about you is inadequate, incomplete or incorrect, you are entitled to have it corrected. 4.3. You may have the right to request confirmation whether or not personal data about you is processed and if that is the case access to your personal data and additional information such as the purposes of the processing. You are also entitled to receive a copy of the personal data about you undergoing processing. If the request is made by electronic means the personal data will be provided in a commonly used electronic format if you do not request otherwise. 4.4. You may object to any processing of personal data on the basis of a legitimate interest, on grounds relating to your particular situation. 4.5. You may have personal data about you erased under certain circumstances. 4.6. You may ask for restriction of the processing of your personal data to only comprise storage of your under certain circumstances. 4.7. You may ask to receive a machine-readable copy of personal data about you which processed on the basis of your consent and which been provided to us by you (data portability). 4.8. You may withdraw your consent to processing of your personal data at any time. 4.9. You acknowledge that you always have the right to lodge complaints pertaining to the processing of your personal data to the competent data protection authority. 5. CONTACTS 5.1. Since Qbtech does not have access to any information which can directly identify you should turn to the test administrator at the Clinic to request exercise of rights under section 4.2 – 4.8 above. 5.2. Qbtech has appointed a data protection officer who can be contacted on personaldata.QbCheck@qbtech.com. CONSENT You as a test person may decide yourself whether information about you will be submitted to, analyzed and stored in the QbCheck. If you are under 18 years old this decision must be taken by your guardian. Please note that you will not be able to perform a test without giving your consent below. By signing below, you confirm that you have received the information above and consent to the following: That information about you about you is processed within the QbCheck for the purposes described above in section 2, including specifically that the Clinic instructs Qbtech AB to manage your information as detailed in section 2.4 above (so that you can no longer be directly identified by the test data in any manner) and use your information as detailed in section 3 above . You may not be covered by your insurance company. Optum Health & United health do not cover this testing procedure, if you have either of these insurance companies, you will be paying out of pocket for this testing. There are several other insurance plans that do not cover remote testing procedures based on plan coverage. By signing below, I admit to being made aware that my insurance may not pay for the cost of ADHD testing via QBCheck, which is the diagnostic testing service offered at Aloha Integrative Mental Health, LLC. The cost of testing includes one QBCheck testing voucher, and the appropriate follow up appointment to review results. If my insurance does not cover the cost of testing, I agree to pay the full cash price of $150 upfront, before any testing will occur, by means of my payment method (credit / debit card) that i have provided to Aloha Integrative Mental Health LLC.