🇮🇳 Patient Consent Form for Sharing Medical Prescription

with Pharmacy, Pathology, and Radiology Service Providers

(As per Indian Telemedicine and Data Protection Guidelines)

I, hereby give my informed consent to my consulting doctor and the platform AIHealthRecorder.com to share my electronic prescription and relevant health information with the following healthcare service providers:

• 🏥 Registered Pharmacies
• 🧪 NABL/NABH-accredited Pathology Laboratories
• 🖼️ Licensed Radiology & Imaging Centers

✅ Purpose of Consent

• Quick and paperless access to medications
• Direct booking and discounted diagnostic/lab tests
• Efficient radiology services with AI-powered integration
• Timely delivery of test results and prescription fulfillment

All services are offered by registered entities as per the Medical Council of India (MCI), Drugs and Cosmetics Act, and relevant Indian laws.

🔐 Privacy & Security

In accordance with the Information Technology Act 2000 (including IT Rules 2011) and the provisions of the Digital Information Security in Healthcare Act (DISHA - draft):

• My health information will be stored securely and transmitted over encrypted channels.
• It will only be shared with authorized and verified providers.
• I retain the right to withdraw my consent at any time without affecting my care.
• No commercial usage of my health data is permitted without my further consent.

🎁 Patient Benefits

• ✅ Best offers on prescribed medicines
• ✅ Special discounts on pathology and radiology services
• ✅ Priority support & scheduling for tests and home collection
• ✅ Access to my digital health records & reports anytime

🖊️ Declaration & Consent

By clicking the "I Give My Consent" button, I confirm the following:

• I have read and understood the purpose and scope of this consent.
• The prescription I provided is genuine and valid.
• I am voluntarily giving my consent to proceed.
• AIHealthRecorder.com is not responsible for:
  • Any fake or invalid prescriptions submitted by users.
  • Pharmacies or licensed professionals rejecting the prescription.
• I understand that submitting fraudulent prescriptions may lead to:
  • Permanent suspension of my access to this platform.
  • Potential legal action.