Consent Form 2

1.
Consent Form
Dear Customer,
Thank you for your decision to take part in our flagship program, which aims to offer
personalized healthcare solutions through our web platform, my XPL. We want to make sure
you are completely informed about the collection and use of your personal data before
moving forward. We are dedicated to safeguarding your information in compliance with
relevant laws and regulations since we value your privacy and data security.
Consent Form:
1. I, hereby provide permission for X Private Limited to gather, use, and keep my personal
information for the following uses:
a. Medical data collecting and health assessment.
b. Provision of telemedicine facilities by Digital Doctors.
c. Periodic health check-ups and other guidance.
d. Referrals to laboratories or clinics for additional testing or professional advice.
2. I am aware that my personal data might contain, among other things, contact information,
demographic data, health information, and any other data required to provide healthcare
services.
3. Types of Data Collected:
I understand that XPL may gather information about, but is not restricted to:
 Personal data (such as name and contact information)
 Health-related data and medical history
 Details on the demographics
 Any additional information required to provide healthcare services.
4. Data Processing and Storage:

I understand that XPL's online health platform will securely store and process my data.
Strict security protocols are followed by XPL to guard against unauthorized access,
disclosure, alteration, and destruction of personal data.
5. Data Disclosure:
I am aware that XPL might transmit my information to clinics and other outside service
providers in order to deliver all-inclusive healthcare services. Except in cases where it is
mandated by law, XPL will not provide my information to any other third parties without
my express agreement.
6. Ability to Revoke Consent:

I am aware that, according to the terms and circumstances of the online health platform
agreement, I may revoke my consent at any time.
I am aware, though, that XPL's capacity to deliver specific medical services can be
impacted by a consent withdrawal.
7. I may reach out to XPL if I have any queries, worries, or would like to exercise my rights
with relation to my personal data.
By clicking I agree below, I consent to the use of my personal information for the purposes
outlined in this document.
I AGREE I DISAGREE & leave the site.
Date: _______________________________
2. Legal Regulatory Applied in the consent form:
1. Sec 6 of Digital Personal Data Protection Act, 2023: The Data Principal's consent must
be free, explicit, informed, unconditional, unambiguous, and accompanied by a clear
affirmative action. The consent should be limited to the personal information required for
that purpose and indicate approval to process personal data for that purpose. As per
section 6 of digital personal data protection act, the consent is acquired by stating the
purpose of collecting the data and explicitly informed about the usage of such data
2. Consent Withdrawal (Sect. 6 of Digital Personal Data Protection Act, 2023): The
Data Principal may revoke her consent at any time, and the process of doing so will be as
simple as it was to grant it. The validity of processing carried out using consent prior to
its withdrawal is unaffected by the withdrawal of consent. Also the withdrawal of consent
clause is also provided as per the provision.
3. Telemedicine Guidelines 2020:
The consent form complies completely with the Telemedicine Guidelines 2020,
guaranteeing that the rules included therein are followed. In accordance with the
recommendations, depending on when the consultation begins, patient consent for
telemedicine consultations is acquired through this consent form.
4. Information Technology Act of 2000:
The consent form complies with the Information Technology Act of 2000 by putting
strong data protection safeguards in place and permitting electronic consent procedures. It
guarantees adherence to legal specifications for online transactions and recognizes the
legitimacy of electronic consent from a legal standpoint. Strict security guidelines for
processing and storing data also comply with the Act's guidelines for data security and
protection.
5. The Information Technology (Reasonable Security Practices and Procedures and
Sensitive Personal Information) Rules, 2011:
By acknowledging and putting strict security measures in place for processing sensitive
personal information, the Information Technology (Reasonable Security Practices and
Procedures and Sensitive Personal Information) Rules, 2011 are applied in the permission
form. The form guarantees the safe processing and storage of personal data, including
medical history and health-related information, that XPL collects on its online health
platform. The consent form complies with the regulations by following stringent security
procedures, which include guarding against unauthorized access, disclosure, alteration, or
destruction of personal data.
6. Indian Contract Act, 1872:
The permission form incorporates a provision from the Indian Contract Act, 1872,
of "Free consent" to guarantee that the individual's consent is given voluntarily and free
from outside influence. By using this form, you may be sure that the person's agreement
to the collection, processing, and storage of their personal data was not gained by fraud,
deception, coercion, undue influence, or mistake. The form attempts to ensure that the
individual's consent is given voluntarily and without any external pressure or
manipulation by clearly outlining the purposes of data collection and processing,
providing transparent information about how the data will be used, and offering the
option to withdraw consent.

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1.

3. Types of Data Collected:

4. Data Processing and Storage:

6. Ability to Revoke Consent:

I AGREE I DISAGREE & leave the site.

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