Almadallah Healthcare Management

Signature

In order to facilitate my request for home country treatment, I hereby permit and consent Bluedot Medical Assistance to get my medical reports from Almadallah Healthcare Management. And to obtain a treatment plan and secure insurance approval, I also give Bluedot Medical Assistance permission to share my medical records with the hospitals and the doctors. I am also aware that Bluedot Medical Assistance will gather my medical records following my hospitalization and submit them to the insurance in accordance with the authority's and the insurance's established procedures.