Declaration/Consent / *

By signing this registration form, I, the undersigned hereby agree, consent and authorize Medanta Hospitals and its authorized affiliates, partners, and associates to the following:

I understand that all data in terms of medical information, images, lab reports, and other relevant (therapeutic/clinical) information is collected with primary aim of providing me with care and treatment. As part of my treatment this information may be shared between different clinical/surgical experts.
That Medanta Hospitals, its physician and medical personnel are authorized to administer and perform medical treatment, procedures, blood transfusions, vaccinations and immunization and such other activities to the patient as the treating team deems necessary in the interest of the patient during the course of the patient care, in Medanta Hospitals, in the ambulance, and in the air ambulance (as applicable).
To collect, use, process, storage, and disclosure of patient’s medical/health information including patient’s personal data, sensitive data, financial data, biological materials (“Personal Information/PI”) for purposes of medical diagnosis and treatment, insurance coverage and claim processing, billing and administrative operations, health awareness initiatives, educational and research activities, and internal analysis. I understand that my data and samples may be shared with authorized research collaborators, commercial partners, or third-party entities strictly for the purposes outlined above, subject to appropriate safeguards necessary for the performance of the contract between me and Medanta for provision of medical services at Medanta (“Authorized Purpose”). In the case of a minor or person with disabilities, I provide this consent in my capacity as their parent or legal guardian in accordance with applicable data protection laws and Medanta’s Data Use and Protection Policy.
To be contacted by the hospital and its authorized associates, partners, and affiliates via phone, SMS, WhatsApp, mail or any other available means of communication, for patient’s appointments, reminders, follow-up care and/ or dissemination of information regarding availability of new therapies/ programmes at Medanta Hospitals including medical awareness.
For further details on Medanta’s data use and privacy practices, please refer to Medanta’s Data Use and Protection Policy available at https://www.medanta.org/policy-and-forms .
For any grievances, withdrawal of consent, or to exercise your rights under applicable data protection laws, please contact Medanta at Tele Medicine Tele.Medicine@Medanta.org .
To adhere to the prevailing billing policy of Medanta Hospitals.
That any dispute of whatsoever nature between Medanta Hospitals and the patient shall be governed by the laws of India and subject to the exclusive jurisdiction of the court/ forums at New Delhi/Hospitals (India).
That the maximum liability of Medanta Hospitals (whether under contract, tort or otherwise) arising out of any instance during the medical treatment of the patient at Medanta Hospitals, shall strictly be limited to the total cost incurred by patient or his/ her relative/ attendants for such treatment hereof at Medanta - Hospitals.

*Aadhar Card: Mandatory

*Hindi Translation