Patient acknowledges and agrees that Travel Clinic NOLA, along with their assigns, will be entitled to use any data, discoveries, results, improvements or other information resulting from the Services for any lawful purpose whatsoever, including, but not limited to, internal research, academic or other publications or commercial purposes. All data will be kept on a Cloud Based system that is password protected, and accessible to Travel Clinic NOLA staff.
I understand the benefits and risks of vaccines or IV fluids and request that it be given to me. I have been provided a copy of the Vaccine Information Sheet(published 2022) and am aware of any possible side effects. I also acknowledge that my private health information will only be shared with others in the interest of treatment, payment, or other necesgary healthcare operations; and by signing below; I accapt the privacy policies of Travel Clinic NOLA. Acoording to SD law 34-22-12.5 we must inform you that record of this vaccine shall will be entered onto the State immunization registry and may be shared. I give my express permission to Travel Clinic NOLA, to obtain and access to all of my medical records. I understand that my personal and medical information may be stored on a password protected secure cloud service.