CONSENT REQUEST FOR SHARING MEDICAL RECORD
In order to provide you Health check privileges & packages under employee benefit scheme provided
by the employer to the employee, HCL Avitas Pvt. Ltd. (HCL Avitas) needs to share your medical
record including but not limited to Preventive health check reports present in the record of HCL
Avitas with the employer.
You are requested to give authorization below to allow HCL Avitas to share your record.
AUTHORIZATION FOR SHARING MEDICAL RECORD
Health check privileges & packages have been provided to me by the employer being dependent of
employee.
I hereby authorize HCL Avitas Pvt. Ltd. (HCL Avitas) to share copies of all my medical record
including but not limited to Preventive health check reports present in the record of HCL Avitas
with the employer. I have been fully explained in the language I understand about the purpose of
giving this consent and sharing my medical record.
TAX IMPACT ON COMPANY SPONSORED SERVICE
Amount sponsored by HCL is added as a perquisite in your package which will be taxable as per
your tax slab.