1. By signing below, I authorize this hospital or any of the other hospital(s) or clinics operating under the brands “Aster”, “Medcare” and “Access” within Aster DM Healthcare and their physicians, consultants, nurses, other medical and non-medical staff, other employees, trainees/ students (collectively the “Authorized Persons”) to conduct any diagnostic examinations, tests and procedures, emergency treatment or services, all routine blood tests, diagnostic tests, scans, and procedures, (including x-rays, CT Scan, Ultrasound), administration and/or injection of pharmaceutical products and medications, laboratory examinations, medications, treatment or radiological, therapeutic procedures and treatments in the judgment of the Authorized Persons, which are necessary to effectively assess and maintain my health and to assess, diagnose and treat my illness or injuries and are deemed necessary or advisable for my curative, rehabilitative, conservative & palliative care.

2. I understand that Medcare Hospitals are training centres for training programs in partnership with DHA. I do hereby also consent to the acceptance of services and access to my health records by the trainees/ students of Aster DM Healthcare.

3. I undertake to inform Authorized Persons about all facts pertaining to my health and previous medical history/ allergies/ specific conditions/disabilities irrespective of its relevance to the procedure diagnosis or treatment proposed to be undertaken at the hospital/clinic. I acknowledge the fact that in case any of my disclosures are found to be untrue or incomplete, neither the hospital/clinic nor the Authorized Persons shall be liable or responsible for any consequences thereof.

4. I do acknowledge that informed consent may be needed for some specific diagnostic tests and surgical procedures and that where my informed consent is required, Aster DM Healthcare will inform me about the inherent risks, benefits, alternative methods of intervention or treatment, the consequences of non-treatment and any expected result or outcome of any such tests, procedures, intervention or treatment.

5. I agree that the healthcare provider(s) involved in my care at this facility will access my health information through the Health Information Exchange System (NABIDH) in accordance with the laws of the United Arab Emirates, Emirate of Dubai Legislation and Dubai Health Authority Policies.

6. I acknowledge that the results of medical treatment, including surgical procedures (if any are required) may not be adequately predicted and neither the hospital/clinic nor the Authorized Persons can give, or is allowed to give, full guarantee or confirmation of the outcome of the treatment, including any surgical procedures I receive.

7. I acknowledge that the hospital/clinic has the authority to dispose of specimens taken for laboratory or pathological examination and I consent to the same. I hereby authorize the hospital/clinic and Authorized Persons to review and/or release my personal health information to other healthcare providers for my better treatment during my hospitalization and thereafter.

8. I hereby authorize and direct the hospital/clinic, and/or Authorized Persons, to provide copies of all my medical records, and all information needed to substantiate payment for such hospitalization and medical care, to government agencies, insurance companies, my family and relatives, and others who are financially liable for my hospitalization and medical care.

9. I have been informed of, and hereby consent to, the following:

   1. That the cost of medical treatment depends on various other factors including but not limited to duration of hospitalization, area of hospitalization, investigations performed, drugs and consumables used, procedures and surgeries performed, the professional fee charged, nature of the illness, the severity of illness and any estimate given by the hospital/clinic or any of the Authorized Persons are merely indicative in nature and the final bill generated will reflect the actual payment due and payable by me or on my behalf to the hospital/clinic and payment is to be made by cash/credit/DD;

   2. That a certain fixed amount will be required to be paid at the time of admission and in case the services are provided as a package, the entire amount for the package needs to be paid on admission itself.

   3. That the running bill of the hospital/clinic shall be settled within the period specified to me or my representative during the hospitalization.

   4. That in case of any adverse eventualities, I promise to arrange the full payment of dues either by me or my Relatives without any delay, and in case of non-payment at the time of my discharge, the hospital/clinic and the Authorized Persons shall take legal and other actions against me and my relatives; and

   5. If covered under the Insurance Company, I agree to fully settle my treatment claim through a written Guarantee of payment (GOP).

10. I acknowledge that I have been made aware of the patient's guide/handouts of patient rights and responsibilities.

11. I consent to receive text messages or e-mails from the hospital or any of the other hospital(s) or clinics operating under the brands “Aster”, “Medcare” and “Access” within Aster DM Healthcare. I also acknowledge I have been made aware of how to access the patient portal for my medical reports.

12. I understand that during hospitalization I should not bring any valuables to the hospital/clinic and the hospital/clinic and Authorized Persons shall not be held responsible or liable for any loss of or damage to these items.

13. I [or the patient named below] understand that Aster DM Healthcare will collect and store information relevant to my health together with other information for the purposes of insurance, administration, and financial matters, including personal contact details (Personal Information). I consent to Aster DM Healthcare using the Personal Information, and sharing the same (limited to the extent necessary) for legitimate purposes, and to meet statutory obligations, including:
     

    1. Sharing Personal Information with:

       1. Other healthcare providers for the purposes of patient care.

       2. My insurer, other third-party payers, agents, and/or consultants for the purpose of reviewing, investigating, or processing any relevant claims for reimbursement and related matters; and

       3. Any relevant government authority in accordance with statutory obligations.

    2. I also consent to Aster DM Healthcare to anonymizing the Personal Information and sharing the same in a non-identifiable, anonymized data format for the purposes of:

       1. Education

       2. Research

       3. Assessing Aster DM Healthcare quality standards and clinical performance; and

       4. Internal business processes
          
          I acknowledge that my Personal Information will be processed in accordance with the Aster DM Healthcare Privacy Policy which has been made available to me and can be accessed here Privacy Policy | Aster DM Healthcare.
          
          1. My objection or withdrawal of consent could mean that Aster DM Healthcare is unable to perform the necessary actions to achieve the purposes set out in this paragraph 13, and that I may not be able to make use of the services and treatments offered by Aster DM Healthcare; and
          
          2. The withdrawal of my consent will not affect the lawfulness of any actions taken by Aster DM Healthcare, or any processing, storage, use or sharing of my Personal Information, based on my consent before its withdrawal. 

14. Our physicians may recommend that you are referred to another of our specialists, within Aster DM Healthcare or those affiliated with us. When any referral is recommended, we ensure that the referral is offered on the grounds of clinical need and in the best interests of our patients. You may not wish to take up the offer of a referral and you may seek the same treatment from a physician of your choice.

15. I have read or have been read to in a language I can understand, and I completely understand this general Consent Form and the requirements and authorizations stated above. I have been given the opportunity to ask questions and I have read the details on my/the patient’s registration form and confirm that they are correct. I have given my consent freely and I understand that my consent will remain in effect unless I withdraw my consent in accordance with this Consent Form or until my treatment is completed.

16. I shall advise Aster DM Healthcare of any relevant changes to my Personal Information as and when appropriate in the context of my future interactions with Aster DM Healthcare.
    
    
17. The word “I” mentioned in this Consent Form shall mean and include the patient or patient’s representative or legal guardian, as applicable and signed herein.

Note:

• For Outpatient - This consent is valid for one year for all future consultations/visits/services at Medcare Hospitals & Clinics unless revoked by the patient.
• For Inpatient - Consent will be given every admission.