SC-Updated Pediatric Registration Form-2021

Consent to NABIDH
The NABIDH HIE is a medium that allows your health information to be shared by participating providers including medical groups, hospitals, labs, radiology centers, and other health care providers through secure, electronic means.
I agree that healthcare provider(s) involved in my care at this facility will access my health information through the Health Information Exchange System (NABIDH) in accordance with the Laws of the United Arab Emirates, Emirate of Dubai Legislation and Dubai Health Authority Policies

Yes (Opt-in)No (Opt-Out)
Participation is voluntary and will not affect your ability to receive medical care. If you optout, the NABIDH will block access to your health information even for emergency treatment.

This means that it may take longer for your healthcare providers to get the medical information they may need to treat you. Even if you do not want to participate in NABIDH, Emirate of Dubai law reporting requirements will still be fulfilled through Public Health Registries and research. This means your health information will be used anonymously
Signature Of Parents or guardian*

Clear
Should be Empty:

Pediatric Registration Form