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Patient Consent Form

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Patient Consent Form

Pakistan Association of Dermatologists
Room 11, 3rd Floor, Taj Medical Complex
M.A. Jinnah Road, Karachi, Pakistan

I, ___________________________permit the Pakistan Association of Dermatologists (PAD) to obtain photographs of myself for educational, medical, scientific, or research purposes. I agree that the photographs and information relating to my case may be published or used for purposes which the PAD deems proper. These uses may include lectures and professional journals. However, I shall not be identified by name in any such publication or use. I understand that in some cases my facial features may be visible and/ or recognizable. Photographs shall remain the property of the PAD. I hereby release the  PAD, their personnel, and any other persons participating in my care or dealing with the photographs from any and all liability which may or could arise from the taking or use of such photographs.
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*If the patient is a minor or is unable to consent in writing for any reason, consent must be given on the patient’s behalf by a parent or legal guardian.

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