Unknown Person Interaction Request – Existing Patient Protection Process

This is the process document when an unknown person requests to interact with a patient and this interaction to be facilitated by Matha Ayurveda Eye Hospital.

At Matha Ayurveda Eye Hospital, we do not normally connect unknown persons with existing our patients on matters of treatment. This is because every patient’s condition is different. Even within the same disease, no two patients present in the exact same clinical stage. Our medical team takes considerable effort to understand each case in detail and explain the condition and treatment plan based on that individual assessment.

Because of this, treatment decisions are expected to be based on direct medical evaluation, rather than comparison with another patient’s experience.

We have a responsibility to protect the safety, privacy, and comfort of every patient our ours and their family. Because of this, any interaction with our patient cannot be one-sided.

If an unknown person is requesting to speak with our existing patient, that person should be comfortable being clearly identified and providing sufficient background details. This allows the existing patient (or parent) to understand who they are interacting with and take a fully informed and comfortable decision.

The same level of care and protection that we extend to our existing patients will be extended to the unknown person as well, once they become a patient of Matha.

To initiate this process, unknown person needs provide the following. We will share these details with patients having similar disease condition and if they are satisfied with your profile and agree, hospital shall facilitate an interaction.

1. Request Letter (handwritten on official letter head) – clearly stating what you want
to understand from our existing patient.
2. Government issued identity proofs (with photo and signature)
3. Government issued address proof
4. Recent Passport size photo (taken within last 3 months)
5. Occupation (including designation)
6. Organization / Business Name
7. Official address
8. Residential address
9. Mobile number
10. A write-up about immediate family (i.e. spouse, children, parents, siblings).
Kindly include details about occupation / study, organization, official address of immediate family.
11. Social media profiles (Facebook, Instagram, LinkedIn of yourself and above family members). Kindly ensure that the profiles are accessible for a few days, as
the existing patient or family may review them.
12. A single PDF file that contains all the medical records of the patient – which will be shared with our existing patient
13. A responsibility declaration (Declaration-1) covering the following – signed by you on Rs 100/- stamp paper and witness signed by family members declared above:

“In consideration of my request to interact with an existing patient, facilitated by Matha Ayurveda Eye Hospital and with full understanding of the responsibility involved, I hereby make the following declaration: I understand that any interaction may involve sharing of personal health information, and I will maintain complete confidentiality and conduct myself in a respectful and appropriate manner at all times. I will not record (audio, video, screenshots, or in any form), store, reproduce, circulate, or share any information obtained, either directly or indirectly, with any individual or on any platform. I will not attempt to contact the patient or their family members directly, either during or after the interaction, through phone, messaging, social media, or any other means, unless explicitly facilitated by the hospital. I understand that any information shared is based on an individual patient’s experience and may not be applicable to my condition, and I will not treat it as medical advice or hold the patient responsible for any decisions or outcomes. I further understand that Matha Ayurveda Eye Hospital is only facilitating this interaction based on mutual consent and is not responsible for any consequences arising from it, and I confirm that I have read, understood, and agree to abide by these conditions without exception.”

14. Responsibility Declaration (Declaration2): signed by you on Rs 100/- stamp paper, and witness signed by family members declared above:

“In consideration of my request to interact with an existing patient, facilitated by Matha Ayurveda Eye Hospital and with full understanding of the responsibility involved, I hereby make the following declaration: I understand that if I proceed with treatment at Matha Ayurveda Eye Hospital, I may, in future, be approached by the hospital with a request to interact with new patients who seek to understand the treatment process. I agree to extend the same openness that I am currently requesting, and to share my experience in a truthful, responsible, and ethical manner, while maintaining appropriate conduct and respecting the guidance of the hospital.”

Submission Process
• You may send soft copies of the above documents via email from your official email ID to [email protected] so that we can initiate the process and share these details with few of our existing patients.
• However, any interaction will be considered only after the hard copy (physical copy) of all documents is received at our end.
• You may send the documents to: Matha Ayurveda Eye Hospital, Jayaprakash Lane, Kudappanakunnu P O, Trivandrum, Kerala 695043, Ph: 0471 2731352

Note:
1. If our existing patient or their family requires any additional information about your profile, the same will be communicated to you through us, and you may be
required to provide those details to proceed further.
2. If you or your family do not have any verifiable public presence, or are not willing to make your identity sufficiently clear, we will not be able to proceed. Access to our patients cannot be extended to unidentified or unverified individuals.