CONSENT FORM At NURA Mongol Screening Center, we respect your rights which are protected by law. Your consent is required before we can process your screening test. Please read the below statements carefully before giving consent. These tests are for screening purposes only and do not constitute a diagnosis. Any medical tests involves some potential risks. For example, taking blood samples may occasionally cause pain, bruising, slight bleeding, light-headedness, fainting and (rarely) an infection or reaction. A screening may not detect all health problems. For example, a prostate-specific antigen (PSA) blood test cannot detect all prostate cancers. A screening helps detect only the possibility of any critical illness, particularly in the early stages, which can be a benign condition. Screening is not a confirmatory procedure. For quality assurance purposes, there is a review process and protocol at NURA Mongol Screening Center. Results are subject to change in the review process, which would also be communicated to me immediately thereafter. You may not be able to have some tests if I am not well, have any contraindications on the day of screening, or have been suffering from or are suffering from any particular medical condition or are undergoing medical treatment. In order to avoid the above happening, you have read the “Points to Consider Prior to Screening” (see the appendix 1) carefully and will intimate NURA Mongol Screening Center if you are not sure of your eligibility for screening. If you have an abnormal screening result, you are responsible for follow-up investigations with the concerned specialists and medical institutions. All reports will have to be corroborated with proper consultation, clinical evaluation, and findings before being acted upon. The fee for the package will not be refundable even if you are not able to have all the tests due to your health conditions. Any personal health information obtained during the screening programme will be confidential and protected. NURA Mongol Screening Center may use, disclose, and process your personal health information, apart from due compliance with statutory and legal mandates, court processes, etc., for the following purposes; Referral to other healthcare professionals, institutions, laboratories, and other associated purposes such as billing, internal administration, and training. Notifying you by SMS and other means of appointment confirmations and reminders. Sending you updates by SMS and other means regarding health-related information as well as marketing and promotional materials. The information in aggregate form may be used for quality assurance, research, development, commercial, educational, or statistical purposes as long as the data does not personally identify you. It is NURA Mongol Screening Center follow-up procedure to contact you about one year from the date you had a screening to determine if all is well with your health journey and ask you about your health status and post-screening follow-up investigations and treatment if you have any. NURA Mongol Screening Center and its employees may communicate with you by email, SMS, telephone or any other medium. On signing the consent, I read, understand, and agree the privacy policy and user agreement that are present on the website. https://nura.mn/terms-of-service;https://nura.mn/privacy-policy I, _________________________________ fully understand and agree with the above statements and will undergo the screening programme provided at NURA Mongol Screening Center. Name______________________________________________________________ Date __________________Signature _____________________________________ Points to Consider Prior to Screening Those who are being treated for the following conditions are advised to consult with their doctor before having a screening: Conditions related to cardiovascular diseases, such as having a pacemaker inserted and post-cardiac surgeries. Conditions related to cancer, such as post-surgery and during chemotherapy. Conditions related to blood disorders. Dialysis Those with the below conditions may not be able to have some tests. CT: pregnancy and pacemaker DEXA: pregnancy and recent gastrointestinal contrast studies Mammography: pregnancy, pacemaker, breast feeding, breast augmentation, and VP shunt Colposcopy: active inflammation of the cervix, during your menstrual cycle Those who are not well are advised to reschedule their appointment for screening. If you have a temperature over 38 degrees or are suffering from and infectious disease, please reschedule your appointment. In some conditions, such as during your menstrual cycle, you may not be able to do some tests. You are advised to reschedule your appointment. If you are in doubt, please call NURA Mongol Screening Center on +976 75887588