Please complete all blanks in either English or Arabic Language

The validity of this consent form is ongoing for all required Home Health Care Service, unless stated otherwise.

Patient Information

Consent Agreement

1. I am fully aware who is in charge of my treatment and I understand that I can get information about my condition at any time by asking my treating doctor. I am aware of potential benefits and drawbacks.
2. My case may undergo examinations, investigations, blood tests, imaging diagnostics, and treatments which are considered necessary by the medical staff for diagnosis and treatment and I have the total right to accept or refuse these procedures.
3. In case I need further interventions, I acknowledge that I have to sign additional consent forms.
4. I agree to attend to all financial responsibilities related to my care.
5. I agree that "care4u" may send copies of my medical records or any other relevant information, to my insurance provider(s) or other sources of payment, as well as any government entity requiring such information. I understand that this information will be sent when needed for payment of my medical bills and/or in case of legal actions.
6. I agree that "care4u" and its affiliates may use my and my dependent's personal data for the purposes of providing the service and associated purposes. "care4u" will keep my information confidential. "care4u" sometimes uses third parties to process data on its behalf.
7. I agree to provide a proper and safe area for Home Health Care Staff.
8. I am obligated to not violate or offend healthcare providers and I will be exposed to legal accountability in such cases.

I, the undersigned,

Have read, understood, and agreed with the above terms and conditions and I take full responsibility of it.