I, the undersigned patient (or legal guardian), hereby give my full and informed consent to Bluedot Medical Assistance Co. ("Bluedot") to act on my behalf for the following purposes, in relation to the coordination of my treatment and/or medical repatriation to my home country:
Access and Collection of Medical Records:
I authorize Bluedot and its team members to collect and retrieve my medical reports, discharge summaries, imaging, and laboratory results from my treating facility/hospital and my insurance provider (Cigna Insurance) in order to support the coordination of continued care, repatriation, or treatment in my home country.
Disclosure to Medical Providers:
I consent to Bluedot sharing my medical records, including any clinical assessments, diagnostic results, and relevant documentation, with selected hospitals, medical professionals, and health facilities involved in preparing a treatment plan or providing medical transfer services. This is done for the sole purpose of obtaining medical opinions, securing treatment options, and facilitating insurance approvals where applicable.
Insurance Communication:
I permit Bluedot to submit any required medical documentation, including hospitalization summaries and treatment records, to my health insurance provider in line with procedures mandated by UAE health authorities and insurance regulatory frameworks, for the purpose of claim submission, pre-approvals, or reimbursement.
Third-Party Handling of Medical Records – Disclaimer:
I acknowledge that while Bluedot will make reasonable efforts to protect the confidentiality of my personal and medical information, once the data is transferred to third parties (such as hospitals, insurance companies, transport providers, or agents) for authorized purposes, Bluedot is not responsible for how these third parties manage, store, or further share such information. I understand that the handling of my data beyond this point falls under the respective party's internal data protection and privacy policies.
Data Protection and Compliance:
I am aware that Bluedot will collect and process my data in accordance with the Federal Decree Law No. 45 of 2021 on the Protection of Personal Data, the UAE Federal Law No. 2 of 2019 concerning the Use of Information and Communication Technology (ICT) in Health Fields, and relevant health authority guidelines (DHA, MOHAP, DOH). This consent is valid unless revoked in writing.
By electronically signing or submitting this form, I confirm that:
I understand the scope and limitations of this consent.
I give this consent voluntarily, without coercion.
I am of sound mind or have legal authority to consent on behalf of the patient.