You have successfully given your consent to Swasth 365 program.
Mankind Pharma Limited, under its brand name Swasth365, provides services, incidental and
ancillary to healthcare services and also conducts surveys like customer satisfaction survey, etc., for
its internal consumption. The service may be provided through Mankind appointed 3 rd
Parties/Affiliates. During this program, Mankind or any of its appointed/designated 3rd party
partners/affiliates may be exposed to certain confidential information capable of being qualified as
personally identifiable information. We respect our subscriber’ rights and work towards
safeguarding such information.
The provision of the services under this program shall be governed by the following terms and
conditions:
• The services provided by Swasth365 will not in any manner, replace and substitute medical
advice and/or change Doctor’s prescription and/or professional guidance.
• Mankind shall in no manner be responsible for any negligence/guidance/medical advice
provided by the professional.
• The Professional has sought appropriate express consents and permissions from its patients
to share their personal and healthcare information under the program.
Swasth365 will keep me informed on a timely basis about the value added services provided to my
patients and their medical health progress.
Doctor’s Name: ________________________
Registration No:________________________
Date: _______________
City: _______________
Doctor’s Signature: __________________
Mankind Pharma Limited, under its brand name Swasth365, provides services, incidental and
ancillary to healthcare services and also conducts surveys like customer satisfaction survey, etc., for
its internal consumption. The service may be provided through Mankind appointed 3 rd
Parties/Affiliates. The following Consent Form is a pre-requisite to be a part of this program and avail
such services. During this program, Mankind or any of its appointed/designated 3 rd party
partners/affiliates may be exposed to certain confidential information capable of being qualified as
personally identifiable information. We respect our subscriber’ rights and work towards
safeguarding such information.
You shall be governed by the following terms and conditions under the program:
We will provide you with all the resources to assist you in your medical condition and
manage it better. We will also assist you, should you have any queries in a language that you
understand. Please note that Swasth 365 does not provide any medical advice and shall not
be liable for any negligence/medical advice so provided by the professionals.
We store, disseminate and process all personally identifiable information in compliance with
applicable laws, as amended from time to time.
By accepting the terms and conditions, you explicitly provide your consent to provide us
with your medical records including Doctor’s Prescription with validity of less than 6 months
from the date of issue, and diagnostics history and to be contacted for follow-ups and
prescription reminder calls. Should you have any concerns, the same shall be addressed
promptly.
Patient’s Consent – By signing this form, I acknowledge that I have read and understood the terms
and conditions. I expressly consent to disclose my personal and medical information and agree not
to hold Mankind Pharma Limited or its appointed affiliates/3 rd party partners, responsible in any
manner. I also understand that I have the right to revoke this consent at any time.
In case of a minor, this consent has been signed by the below named person in his/her capacity of a
guardian.
Subscriber’s Name: _______________________ Gender: _________ Age: _________
Date: _______________________
City: _______________________
Subscriber’s Signature: ________________________
OR
Subscribers’ Caretaker’s Signature: ________________________