Expressed Consent of a Healthcare Provider for providing Telemedicine Services

I, hereby give my express consent to register as a healthcare provider and provide telemedicine services using technology offered by Healthy Cosmos Private Limited (hereinafter referred to as “the Company”). I understand and agree to the terms and conditions set forth in this consent form.

Qualifications and Credentials:

a. I hereby confirm that I possess all the necessary qualifications, certifications, licenses, and credentials required by law to practice medicine in India and deliver Telemedicine services.

b. I agree to provide valid and up-to-date documentation of my qualifications and credentials to the Company.

Provision of Telemedicine Services:

a. I understand that the Company operates a telemedicine platform that allows healthcare providers to deliver medical services remotely.

b. I agree to provide telemedicine services to patients through the Company’s platform in accordance with applicable laws, regulations, and industry standards.

c. I will adhere to the Company’s policies, guidelines, and protocols while providing telemedicine services.

d. I will maintain the privacy and confidentiality of patient information in compliance with applicable laws, including but not limited to, the Health Insurance Portability and Accountability Act (HIPAA) and the General Data Protection Regulation (GDPR).

Professional Responsibility:

a. I acknowledge that I am solely responsible for diagnosing and treating patients within the scope of my professional expertise and in compliance with applicable laws and regulations.

b. I will exercise reasonable care and judgment when providing telemedicine services and will refer patients to appropriate in-person care when necessary.

c. I understand that the Company does not assume liability for my professional actions or decisions while providing telemedicine services.

Termination:

a. Either party may terminate this consent agreement with written notice to the other party.

b. Upon termination, I will discontinue providing telemedicine services through the Company’s platform and return any confidential information or property belonging to the Company.

Governing Law:

This consent agreement shall be governed by and construed in accordance with the laws of India. Any disputes arising out of or in connection with this agreement shall be subject to the exclusive jurisdiction of the courts in India.

I affirm that all information provided is true and legally accurate to the best of my knowledge. I have not concealed any facts. I acknowledge that I am fully responsible and liable for any misrepresentations or false information.

I share an expressed consent to receive electronic messages from Healthy Cosmos Pvt. Ltd., its employees, affiliates, associates, partners, agents, associated healthcare professionals and digital platforms including personalized marketing materials relating to products, services, therapeutic areas, disease state information, invitations to participate in events, consultations or activities organized or sponsored by Healthy Cosmos Pvt. Ltd. and other general marketing communications, announcements and newsletters that they may send to me from time to time for the purpose of sharing information and developing and managing our professional relationship.