:// ftp 172.18.255.

2/Checklists/
OPENED DATE - 11/06/2016
EXPIRY DATE - 11/07/2016

OPENED DATE - 11/06/2017

EXPIRY DATE - 11/07/2017

INFECTIOUS WASTE

I consent to the procedure of carrying out laboratory blood test for HIV/AIDS (Acquired immune
Deficiency Syndrome) and /or Hepatitis.

I further confirm that physician or Laboratory supervisor have explained to me in details the
consequence of blood test being positive.

Prevailing Qatar laws state that all proved cases of Hepatitis and HIV/AIDS must be reported to
the Health Authorities, Legal procedure, including suspension from work and deportation can
happen against infected individuals.

Signature of patient Date & Time

:// ftp 172.18.255.2/Checklists/
OPENED DATE - 11/06/2016
EXPIRY DATE - 11/07/2016

OPENED DATE - 11/06/2017

EXPIRY DATE - 11/07/2017

INFECTIOUS WASTE

SUBSTITUTE CONSENT GIVER

If the patient cannot consent for him /her self, the

signature of the parent, health care provider, legal
guardian or substitute consent giver who is acting on behalf
of the patient, or the patient’s next of kin who is
assenting to the treatment for the patient, must be
obtained.

I of Nationality, Years old. Holder

of Q.I.D number Type do hereby declare that I am the guardian
/substitute consent giver for the patient in my capacity as I have
been asked in the best interests of patient to sign this declaration and consent required by the
hospital /Clinic as the patient is incompetent to do so.

Name& signature of Substitute Consent Giver Date & Time

WITNESS
:// ftp 172.18.255.2/Checklists/
OPENED DATE - 11/06/2016
EXPIRY DATE - 11/07/2016

OPENED DATE - 11/06/2017

EXPIRY DATE - 11/07/2017

INFECTIOUS WASTE

I am Aster Medical Centre plus Lab – Old Alghanim employee who is not the
patient’s physician or authorized health care provider and I have witnessed the patient or his/her
substitute consent giver voluntarily sign this form.

Name title, Designation of Witness Signature Date & Time

:// ftp 172.18.255.2/Checklists/
OPENED DATE - 11/06/2016
EXPIRY DATE - 11/07/2016

OPENED DATE - 11/06/2017

EXPIRY DATE - 11/07/2017

INFECTIOUS WASTE
:// ftp 172.18.255.2/Checklists/
OPENED DATE - 11/06/2016
EXPIRY DATE - 11/07/2016

OPENED DATE - 11/06/2017

EXPIRY DATE - 11/07/2017

INFECTIOUS WASTE
:// ftp 172.18.255.2/Checklists/
OPENED DATE - 11/06/2016
EXPIRY DATE - 11/07/2016

OPENED DATE - 11/06/2017

EXPIRY DATE - 11/07/2017

INFECTIOUS WASTE
:// ftp 172.18.255.2/Checklists/
OPENED DATE - 11/06/2016
EXPIRY DATE - 11/07/2016

OPENED DATE - 11/06/2017

EXPIRY DATE - 11/07/2017

INFECTIOUS WASTE