Personal data processing Policy

CONSENT FORM FOR PROCESSING OF PERSONAL DATA 

Data principal Name: 

Age: 

Gender:

Location:

Address:

Date of consent: 

Please read through the following statements and signify your consent, if you agree with the statement: 

  1. I am availing teleconsultation services from registered medical practitioners (RMP) with the help of health workers and using the platform of Intelehealth. 

  1. RMP, health worker, and Intelehealth will ask for my personal data including medical history, laboratory reports, test findings, health data, and other information for teleconsultation and providing me with telemedicine and telehealth services, that I wish to undertake for my medical condition.

  1. Additionally, my personal data collected shall be processed by Intelehealth for creating medical records, communicating with me for reminders, prescriptions, and other matters connected with teleconsultation and services availed by me, and compliance with applicable law. 

  1. Further, my personal data will be deidentified or anonymized by Intelehealth to undertake research, disease monitoring, and analysis to improve their products and services. 

  1. The details of what and how my personal data would be processed by Intelehealth has been provided for in its terms of use https://intelehealth.org/terms-of-use/ and privacy policy – https://www.intelehealth.org/privacy-policy. 

  1. Intelehealth, RMP, health worker may make notes during the consultation, prepare written reports and prescriptions, and other documents containing my personal data; all of such documents will be treated as my personal data.

  1. I shall have a right to access, review, and rectify my personal data, and for repeated requests, Intelehealth may charge a reasonable fee. 

  1. I shall have a right to receive a copy of my personal data, and for repeated requests, Intelehealth may charge a reasonable fee. 

  1. I shall have a right to withdraw your consent. If I withdraw my consent, RMP, health worker, and Intelehealth shall have no obligation to provide me with teleconsultation as the same would not be possible without processing my personal data. Any processing done prior to withdrawal of consent shall remain as-is.

  1. Processing of my personal data will be as per applicable law. 

  1. No information in an identifiable format will be disclosed to any third-party without my consent, except disclosure that is essential for providing me teleconsultation services or compliance with applicable law.

  1. Intelehealth provides physical, electronic, and procedural safeguards to protect the personal data that it processes and I have been made aware of such measures, which are also captured in the privacy policy.

  1. I can reach out to Intelehealth if I have any queries regarding the processing of my personal data at support@intelehealth.org and Intelehealth will respond in a reasonable time.

Consent: 

I have read and understood the notice for consent. The details have been explained to me and I am aware of the consequences. With all required information, I hereby give my explicit, free, unconditional, and informed consent to the processing of my personal data for the stated purposes. 

Acceptance through tick mark to record consent