PATIENT CONSENT AND SERVICES AGREEMENT
PATIENT CONSENT AND SERVICES AGREEMENT
1. “Patient” who will receive services under the agreement.
2. “LAR” legally acceptable representative of PATIENT.
3. “PHA” refers to as ProCare Health Advisors Pvt. Ltd.
2. General Terms
1. PHA services are non-transferable and only cover the patient named in the Patient Services
2. The PATIENT/LAR confirms that the nature and scope of Services have been fully explained to him/
3. The Patient has further completed the Patient Registration Form providing general details,
physician details, emergency contact details, medical history including pre-existing medical condition
and medication information to the best of his/her knowledge.
4. PHA services are not a substitute for emergency medical services offered at hospitals. In case of a
a medical emergency, the caregiver should contact emergency service providers such as ambulances
and/or rush to the nearest hospital along with informing PHA about it.
3. PATIENT/LAR Rights
1. Be treated with courtesy, dignity respect &be cared for by suitably qualified and trained healthcare
staff at all times.
2. Have personal and medical information privacy and confidentiality protected as per prevailing
3. Have complete information to make an informed decision with respect to the proposed Services being
4. Express concern or complain about the care or services provided to them or provide candid feedback
on the PHA staff.
5. Request with supporting reasons for change of PHA Care Professional or any other service.
6. LAR shall have a right to terminate this agreement with or without cause or in the event of
4. PATIENT/LAR Obligations:
1. To provide full and aPHArate information about PATIENT’s health, medical history and personal care
needs to the PHA Care Professional.
2. To strictly adhere to the advice and instructions given by the Treating Physician.
3. To inform Treating Physician immediately, if:
3.1. changes in his / her health condition or care needs; or
3.2. a medical emergency develops; or
3.3. PATIENT’s health deteriorates abruptly; or
3.4. In the unfortunate event of PATIENT death.
4. To provide following documents for PATIENT including one (1) Proof of Identity and one (1) Proof of
5. To provide the address of PATIENT/family member where the PHA Staff will be required to report to
in writing and ensure that the said address is a safe and habitable place for PHA Homecare Staff.
6. In case the PATIENT/LAR wishes to change any scope of Services or PHA Staff or equipment, the
same needs to be intimated to PHA in writing along with supporting reasons in advance. PHA shall
review and approve the change request in its sole discretion.
7. To inform PHA of any non-availability of PATIENT due to travel etc. at least 2 business days in
advance. In case of failure to inform, the Services shall be deemed to have been rendered by PHA
until PHA or PHA Staff becomes aware of the absence of the PATIENT.
8. To treat all PHA Staff or representative involved in the Services, whether residential or not, with
courtesy and respect at all times. Any kind of violent or abusive behavior including foul language,
physical attack or assault, mental harassment, sexual assault and harassment is unacceptable. Any
10. such acts shall result in immediate termination of contract apart from other suitable police and
legal action by PHA.
11. Any acts of individual misdemeanor or any unlawful behavior on part of any PHA employee/worker/
staff provided would not bind PHA into any legal culpability.
101, Rashmi Rathi, Plot No.190, Charkop sec 6,Kandivali West ,Mumbai-67
Procare Health Advisors Pvt. Ltd.
R.O. – 101 Rashmi Rathi, Plot No. 190, Sector 6 Charkop,
Kandivali (W), Mumbai – 400067
12. The PATIENT/LAR will not hire or seek to hire any PHA Staff directly or indirectly, or solicit, induce,
recruit or encourage any of PHA employees or independent contractors to leave their engagement
with PHA for any reason. Any such action will render PATIENT/LAR liable to pay liquidated damages
towards loss of cost incurred for recruitment and training of the PHA Staff The PATIENT/LAR agrees
that the nurse, attendant or any other staff sent by PHA to his/her home is for the exclusive
purpose of rendering services to the PATIENT only and will not be asked to perform any other
household functions or chores.
13. The PATIENT/LAR understand that the PHA Staff are neither authorized to accept, have custody of
or have the use of cash, credit or debit cards, bank cards, Cheques or other valuables belonging to
PATIENT or family members and nor are they to be paid any kind of cash by PATIENT/LAR.
14. The PATIENT/LAR is responsible to protect his/her valuables and keep them in safe custody during
period of visit by PHA staff. PHA will not be responsible for any such theft or misappropriation and
will not pay any claims pertaining to such unauthorized use, theft or misappropriation.
15. The PATIENT/LAR shall take good care of the equipment belonging to PHA or its contractors which is
placed at the residential address of the PATIENT for delivery of Services. In case of any loss or
damage to such equipment due to any act or omission of the PATIENT/LAR or other oPHApants of the
premises, the PATIENT/LAR shall make good such loss or damages to PHA.
5. PHA Rights
1. PHA reserves the right to demand agreed fees in advance and get paid by PATIENT/LAR in advance. In
case the amount is not paid within the stipulated period, PHA reserves the right to cease delivery of
services without prior notice.
2. PHA will get suitably reimbursed for all additional or out of pocket expenses incurred by it for
services provided to PATIENT.
3. PHA may sub-contract any or all services agreed under the Patient Services Agreement to third party
partners such as Lab & Diagnostic Vendors, Emergency/Ambulance Services Vendors, Medical
Equipment Vendors, Health Check-up Partners, Distributors, Chemists etc. to provide value added
services to PATIENT.
4. PHA will record, save and store all personal information including health related information of the
PATIENT electronically in a secure database. PHA will however not be responsible for any inadvertent
cyber data theft from its website or databases.
5. PHA shall further organize a basic medical assessment of the PATIENT if it so deems fit for the
purpose of ascertaining eligibility of the PATIENT.
PHA shall have a right to terminate the Patient Services Agreement with or without cause or in the event
of patient death as per Clause 9.3.3without advance notice to the PATIENT/LAR.
6. PHA Obligations
1. Provide suitably qualified and trained medical and paramedical staff to PATIENT.
2. Ensure proper background checks for all staff deployed for services to the PATIENT.
3. Ensure proper uniform, hygiene and upkeep of all staff resources deployed at PATIENT’s address.
4. Maintain PATIENT health data, reports, charts in a physical or electronic file for easy reference.
5. Ensure privacy and confidentiality of all PATIENT data as per stipulated government guidelines and
paramedical staff in course of the Services or when medically necessary.
7. Indemnification and waiver of liability
To the extent permitted by law, the patient/LAR hereby waives his/her right to initiate a claim, action,
suit, or legal proceeding including Criminal Proceedings by whatever name called against PHA and its
directors, agents, employees and contractors arising from
A. Any pre-existing medical condition of the patient; or
B. Any adverse drug reaction; or
C. Medical procedure related condition that is not connected to PHA.
D. Any services which are not directly provided by PHA.