Tip for EEOC-compliant notice

GINA prohibits employers from using genetic information (including family medical history) in employment decisions

Tip for EEOC-compliant notice

You are NOT required to provide genetic information to your employer — participation is always voluntary

Tip for EEOC-compliant notice

If you believe your employer has violated GINA, file a complaint with the EEOC at https://www.eeoc.gov/

Genetic Testingeasy

GINA Notice (Employer Wellness Programs)

EEOC-compliant notice · Employers

Notice to employees about GINA protections when wellness programs request genetic or family history information. Employers with 15+ employees cannot use genetic information in employment decisions.

Form Details

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Where to Submit This Form

🏢

Provided by the employer to employees participating in wellness programs that collect genetic information

This notice is an employer obligation under the Genetic Information Nondiscrimination Act (GINA).

Required Attachments

📎 GINA-compliant notice to employee (provided by employer)
📎 Employee acknowledgment of receipt (if required by program)

Processing Time

Immediate. This notice must be provided before any genetic information is collected through a wellness program.

What Happens Next

Providing genetic information in a workplace wellness program is voluntary. Genetic information cannot be used for employment decisions. The information must be kept confidential and separate from personnel files.

Tips for This Form

✓ GINA prohibits employers from using genetic information (including family medical history) in employment decisions
✓ You are NOT required to provide genetic information to your employer — participation is always voluntary
✓ If you believe your employer has violated GINA, file a complaint with the EEOC at https://www.eeoc.gov/
✓ GINA protections apply to employers with 15 or more employees, employment agencies, and labor unions

More Genetic Testing Forms

Genetic Testing Prior Authorization

Insurer-specific · Health insurance plans

Request for coverage of genetic tests (BRCA, Lynch syndrome, pharmacogenomics, carrier screening, etc.). Must meet personal and/or family history criteria.

Genetic Testing Lab Requisition

Lab-specific (Invitae, Myriad, Ambry, GeneDx, etc.) · Genetic testing laboratories

Lab-specific order form including clinical indications, family history, insurance information, and patient consent. Labs often handle prior authorization directly.

Genetic Counseling Referral Form

Provider/insurer-specific · Healthcare systems / HMOs

Referral for genetic counseling services. Required by HMOs and some PPOs before genetic testing. Genetic counselors provide pre- and post-test counseling.

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