Patient Consent Form

Operated by: Medpro Essentials Ltd

This form is to be completed by the patient (or their legal guardian) upon registration at a GP practice using the Kairo Practice Management System. Please read carefully before signing.

About This Form

Your GP practice uses Kairo, a secure practice management system, to manage your medical records, appointments, prescriptions, and communications. This form explains what data we collect, how it is used, and your rights.

1. Practice Details

2. Data We Collect About You

Your practice will record the following information about you in the Kairo system:

Personal Information

• Full name, date of birth, gender, and title
• Contact details: home address, phone number, mobile number, email address
• National ID number or passport number
• Preferred language and interpreter requirements
• Emergency contact details (name, phone number, relationship)

Medical Information

• Medical history including chronic conditions, past surgeries, and known allergies
• Consultation notes from each visit (SOAP format: subjective, objective, assessment, plan)
• Prescriptions issued including medication names, dosages, and instructions
• Documents: lab results, referral letters, discharge summaries, scan reports, ECG results
• Clinical alerts: allergy alerts, medical alerts, communication preferences
• Appointment history and attendance records

Billing Information

• Invoice history and payment records for services received
• Medical aid or insurance membership details (where applicable)

3. How Your Data Is Used

Your data is used by the practice for:

• Providing and managing your healthcare, including appointments, consultations, and prescriptions
• Maintaining an accurate medical history to support your ongoing care
• Sending appointment confirmation and reminder messages by SMS and/or email
• Processing invoices and payment records for services rendered
• Referring you to other healthcare providers (with your knowledge)
• Meeting our legal obligations under Zimbabwe health and data protection regulations

4. Who Can See Your Data

Within the Kairo system, access to your data is restricted by role:

• GPs and Nurses: full access to clinical records, consultations, and prescriptions
• Receptionists: limited access — can view basic information and manage appointments
• Practice Managers: billing and administrative access
• Practice Administrators: full administrative access for system management

Kairo's technical team may access anonymised system data for maintenance purposes only and cannot access clinical record content.

5. SMS & Email Communications

Your practice may send you the following communications through Kairo:

• Appointment confirmation messages (SMS and/or email)
• Appointment reminder messages (sent approximately 24 hours before your appointment)
• Practice notifications as directed by your GP

SMS messages are delivered via Twilio (a third-party service provider). Your phone number and message content are transmitted to Twilio for delivery purposes only.

6. Data Retention

Your medical records will be retained for a minimum of 7 years from your last consultation, or until you reach age 25 (whichever is longer), in accordance with Zimbabwean medical records regulations. Billing records are retained for 7 years for financial compliance purposes.

7. Your Rights

Under the Zimbabwe Data Protection Act, you have the right to:

• Access: request a copy of the personal data held about you
• Rectification: request correction of inaccurate information
• Erasure: request deletion of your data (subject to medical retention obligations)
• Restriction: request we limit how we process your data
• Objection: object to certain types of processing

To exercise any of these rights, please contact your practice directly.

8. Consent Declaration

Please tick each box to confirm your consent:

9. Signature