ॐ त्र्यम्बकं यजामहे सुगन्धिं पुष्टिवर्धनम् ।उर्वारुकमिव बन्धनान् मृत्योर्मुक्षीय माऽमृतात् ॥
How the Trust uses these details
Please read this before the form is sent. It explains what the Trust collects about the patient, why, who else sees it, and how long it is kept.
Consent notice version 1.0, effective 2026-09-19
Who is responsible
Mahamrityunjaya Charitable Trust is responsible for the information on this form. You can write to us about it at privacy@mmct.life.
What we collect
The patient's name, age, gender, address and phone number; their diagnosis, treatment, hospital and doctor; the family's annual income; the documents attached to this form; and the name and contact details of the person referring them.
Why we collect it
To decide whether the Trust can pay for this patient's cancer treatment; to check what this form says against the hospital, the doctor and the income documents; to pay the hospital directly; and to follow up on the patient after treatment.
Who else sees it
The hospital and the doctor treating the patient, so that treatment and payment can be arranged. Nobody else, unless the law requires it. The Trust never pays a patient or a relative, and never sells or shares these details for any other purpose.
How long we keep it
Ten years if the Trust pays for treatment, because the case forms part of our audited accounts. Two years if it does not.
Your rights
The patient, or their parent or guardian, may ask us what we hold, ask us to correct or erase it, nominate someone to act on their behalf, or withdraw consent at any time by writing to privacy@mmct.life. Withdrawing consent is as easy as giving it, though the Trust may not be able to continue assistance without it. A complaint may be made to us at privacy@mmct.life and, if it is not resolved, to the Data Protection Board of India.
If the patient is under 18
We need the consent of a parent or lawful guardian. They sign below in the patient's place, and we will confirm it when we call.
Consent of the patient
I have read this notice, or it has been read to me in a language I understand. I agree to the Trust collecting and using these details for the purposes described above, and to sharing them with the hospital and doctor treating the patient. I understand that I may withdraw this consent at any time by writing to privacy@mmct.life.
If the patient is under 18, or is unable to sign, a parent or lawful guardian signs here instead.