Terms and Conditions
INFORMED CONSENT AND WAIVER OF LIABILITY
By signing this form, I acknowledge that I understand and agree to the following:
PARTICIPATION CONSENT
- That I voluntarily participate and share my “Information” (Demographics, PHI(Patient Health information) and all other Health data inclusive of Family health history) in the integrated medicine disease management program (“Program”) by Jivaayush Healthcare Private Limited (“Health”) for availing treatment for some specific diseases and regenerative medicine (“Purpose”).
- That I understand that my participation in the Program is voluntary and that I am free to withdraw at any time, without giving any reason, without my medical care or legal rights being affected.
- That I affirm, by my signature on this form, that the medical information I have provided in this Program is true and correct, to the best of my knowledge. Furthermore, I understand that if I give false or inaccurate information (i) Zveta.Health has the right to remove me from the Program with immediate effect; (ii) Zveta.Health would not be held responsible for any side-effects caused due to incorrect disclosures; and
- That I hereby give my express written consent to Zveta.Health to retain the results of the study for record purposes provided however that it implements reasonable security practices and procedures to protect the results.
- That, for the said Purpose, I hereby give my express written consent to Health to retain and use the results of the study for the Purpose as long as required by Zveta.Health and transfer it to any person, provided however that Zveta.Health and any such person implements reasonable security practices and procedures to protect the results.
DATA COLLECTION
- That I confirm that I am aware that my personal information, including my health information and medical records, have been collected with my consent by Zveta.Health for the Program. I understand that collection and processing of my information is necessary for Zveta.Health to carry out the study & treatment required for the Purpose.
- That I further confirm that I am aware that such Information is collected by Zveta.Health , its physician or healthcare professionals with my consent for the purpose of remotely monitoring and analyzing certain health conditions as part of the Program.
- That I further agree to the proposition that my Information may be disclosed and/or transferred to third parties that Eldricare chooses, solely in relation to the Purpose.
- That I confirm that I am freely providing this consent of my own volition.
- That I am aware that I have a choice to refrain from disclosing my information. I understand that in the event I fail to disclose my medical records correctly to Zveta.Health, Zveta.Health will not be held liable for any side effects or health issues from the treatment. I also understand that if I withdraw from the Program, Zveta.Health will stop the treatment immediately and I would not be part of the Program.
TESTIMONIAL CONSENT
- That I consent to the use of all my “Information” collected by Health (“Testimonial”) for the creation of materials that will be used for the promotion and marketing in india as well as abroad.
- That I hereby permit Health to disclose and/or transfer my Information to third parties in India or abroad for the purpose of conducting and/or concluding the customer-feedback survey and for the creation of the Testimonial.
- That I hereby agree to have my name and likeness (such as a photograph or video) appear in the Testimonial and/or in any posting or publication of the Testimonial.
- That I hereby clarify that I have no objections to the Testimonial being made public.
- That I understand that Health is not obligated to publish the Testimonial, and that if it does, I will not be entitled to any payment or royalties.
- That I hereby assign to Health all copyrights in the Testimonial and derivative works. I authorize Zveta.Health to modify, edit and adapt the Testimonial as it deems fit, including, without limitation, the right to use the Testimonial in whole or in part or in conjunction with other testimonials. I renounce any right to inspect or approve the finished product, including the written copy or edited video in which the Testimonial appears.
- That I understand that I have the right, at any time, to revoke my consent for the use of the Testimonial. I hereby acknowledge and agree that, in the event that the Testimonial was published prior to my revocation of consent, Health will take reasonable efforts to take down the Testimonial wherever possible, but that it would be impractical and impossible to delete all traces of the Testimonial from the internet.
WAIVER OF LIABILITY
- That I have voluntarily chosen to be bound by this waiver of liability statement.
- That I hereby completely and irrevocably release Zveta.Health and its staff member, technicians, physicians and other healthcare professionals, insurance providers, administrators, officers, employees and directors (collectively, the “Released Parties”) from any and all claims, actions, damages, costs and any other losses of any kind whatsoever arising from, or relating to Program and any actions taken or omissions done on the basis of the Program. Furthermore, I agree that the Released Parties have no liability or responsibility for the accuracy or completeness of the medical information submitted to them or for any errors in its electronic transmission.
- That I irrevocably waive any claim against Health and the Released Parties and agree not to bring any claims, demands including invasion of privacy, infringement of copyright or right of publicity or any other claim which I and my heirs, representatives or any other person acting on my behalf have or may have in relation to the collection, storage, disclosure, transfer and handling my personal health “Information” for the Purpose and use of the Testimonial.
PATIENT’S STATEMENT
- I have read this document and I am affixing my signature out of my free will to indicate my acceptance of its contents. I have been given the opportunity to ask questions before I sign, and I have been informed that I can ask questions at any time.
- I confirm that I have attained the full age of majority, or, in the alternative, I have indicated that I am the legal representative or legal guardian appointed by the courts of India for the patient who will participate in the Program, and I am capable of signing this form on behalf of the patient.