Family Registration Form
Register your family for comprehensive medical data management
Register your family for comprehensive medical data management
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Click on the image to view in full size
By submitting this registration form, you agree to provide accurate and complete information about your family members. The data collected will be used solely for medical record management and healthcare services.
We are committed to protecting your personal and medical information. All data is stored securely and will only be accessed by authorized healthcare personnel and administrators.
You are responsible for ensuring that all information provided is accurate, complete, and up-to-date. Please notify us immediately of any changes to your family's medical information.
Upon successful registration, a medical card will be generated for your family. This card will contain your family's medical information and can be used for healthcare services.
Photos uploaded must be clear and recent. By uploading photos, you confirm that you have the right to use these images and they accurately represent the family members.
Registration in this system implies consent for healthcare providers to access your family's medical records when providing medical services.
Your family's medical data will be retained as per healthcare regulations and may be used for medical research, statistical analysis, and healthcare improvement purposes (with appropriate anonymization).
You have the right to access, review, and request corrections to your family's medical information at any time by contacting the administration.
The system administrators are not liable for any errors in data entry or technical issues that may occur during registration or data management.
We reserve the right to modify these terms and conditions. Registered families will be notified of any significant changes.
Validating data...
Saving family information...
Processing photo uploads...