CONSENT REQUEST FOR SHARING MEDICAL RECORD

I hereby understand and confirm that:

1. The information collected by HCL Avitas forms a part of my confidential patient records which will be stored securely by HCL Avitas.
2. Such information will be used by HCL Avitas for carrying out my medical examination and taking further medical decisions safely and accurately.
3. Such information will not be disclosed to any third party or individual except as allowed herein and if required under the law.
4. Such information may include interaction with me through audio, video and/or other virtual modes of communication, which would be recorded upon my expressed consent for the same as per the applicable laws, including but not limited to the Telemedicine Guideline, the Digital Personal Data Protection Act.
   1. Any such recording may also include photography and/or televising of any procedure(s) to be performed upon me, which would be recorded upon my expressed consent for the same as per the above.
5. Any such recording (audio, video, photograph) may also be used by HCL Avitas for its internal training and quality purposes, where my individual identity will not be revealed/disclosed in any manner.
6. Any such information (audio/video recording, photograph, description) may also be used by HCL Avitas for the purpose of advancing medical education and/or its publication in scientific journals, newsletters, websites, etc., where my individual identity will not be revealed/disclosed in any manner.
7. In case HCL Avitas proposes to reveal my identity or use my information (including audio/video recording, photograph, description) in any manner, it will not be done without my prior explicit informed consent in writing.
8. As part of its communication regarding health promotion, health education, health advocacy, and information on existing and new offerings, HCL Avitas may send relevant communication through appropriate modes including but not limited to, WhatsApp, SMS, e-mails, and channels to me from time to time.

I acknowledge that I have read and understood the information provided above and also agree to the Privacy policy of HCL Healthcare (https://hclhealthcare.in/privacy-policy/). I hereby voluntarily consent to the use of my medical data and information as described herein.