What is the patient general consent form?

The General consent form is a mandotary document to be signed the first time you visit UPANDRUNNING as a new patient. The contects of this form are as below-> GENERAL CONSENT TO TREATMENT Thank you for choosing UPANRUNNING Integrated Sports Medical Center for your medical needs and treatment purposes. Please read through our terms and conditions of services, followed by your Rights and Responsibilities. This is in accordance with the UAE Laws and Regulations. TREATMENT MODALITIES This is to allow our facility to render medical care, treatment and agree to accept services which may diagnose and treat your medical condition. I understand that these services will be provided to me by Physicians, Nurses, Physiotherapists and other health care providers. I understand that my agreement to accept these services is called a “General Consent” and that includes any routine treatment(s) or procedure(s) such as physical examination, blood extraction, administration of medication, use of local anaesthesia, referring patients for diagnostic procedures such as x-rays, MRI’S, ultrasounds, and other non-invasive procedures such as shockwave Therapy. PRP injections, intra-articular injections, dry needling, physiotherapy and rehabilitation and others. I understand that some of the healthcare providers may be trainees under the supervision of the professional clinicians. They may participate or be involved in my treatment and I consent to such a role. I do acknowledge that informed consents may be needed for other detailed diagnostic tests and surgical procedures. I understand that the results of my medical treatments and surgical procedures cannot not be adequately predicted. Our facility or the attending medical team cannot guarantee or confirm a conclusive outcome for your treatment. I understand that my consent to accept these services will remain in effect unless I otherwise say, “I no longer need these services” or until my treatment is completed. I grant permission for my medical file to be used for clinical research with the understanding that my identity shall remain confidential. I accept full responsibility for my personal belongings, including dentures, jewelry, eyeglasses, money and all other valuables. I have been informed about patient’s rights and responsibilities. Patient Rights and Responsibilities

  • Right to receive care.
  • Right to dignity, respect and confidentiality.
  • Right to privacy and safety.
  • Right to informed consent.
  • Right to a second opinion.
  • Right to know more about my healthcare provider.
  • Right to refuse treatment.
  • Right to appropriate assessment.
  • Right to have pain management.
  • Right to complain.
  • Right to an itemized bill and discharge summary.
  • Right to a medical report after paying a reasonable fee.
  • Responsibility to show consideration to other patients and staff.
  • Responsibility to show privacy, confidentiality, dignity and safety to other patients.
  • Responsibility to be truthful and accurate with your information, make sure we are aware of all allergies. Keep us updated with any changes in health or circumstances.
  • Responsibility to take and act on advice given to you by your licensed practitioner.
  • Responsibility to ask questions when in doubt.
  • Responsibility to take responsibility if you refuse care and/or decide not for follow treatment plan.
  • Responsibility to keep your appointments or cancel in advance.
  • Responsibility to observe and follow fire and safety regulations including the no smoking policy.
  • Responsibility to ensure that the financial obligations of services and treatments provided for your care are promptly fulfilled.

  Release of Medical Information On completion of this form you are authorizing UPANDRUNNING to release necessary information about you to third parties. This will include, insurance companies as well as other healthcare providers, laboratories and radiology centers etc. Financial agreement We are not currently a Direct Billing Medical Center, therefore patients must pay for their treatment and we will do our best to help you with the reimbursement of your medical costs. For certain procedures we will contact your insurance provider first to seek approval of coverage before we go ahead. Or you may decide to self-pay or claim from your sponsor company. However, the patient has the overall responsibility to cover the costs, including any outstanding amount if the insurance company makes a partial payment. I have read all the above information and I agree to UPANDRUNNING’s Terms and conditions including my Rights and Responsibilities.

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