Patient and Patient Relative Personal Data Processing Consent Form

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  • Patient and Patient Relative Personal Data Processing Consent Form

Patient and Patient Relative Personal Data Processing Consent Form

EXPLICIT CONSENT TEXT REGARDING THE PROCESSING OF PATIENT AND PATIENT RELATIVE PERSONAL DATA

I have read the Information Notice regarding the Processing of Personal Data of Patients and Patient Relatives and within this scope:

I hereby declare that I give my prior consent to the collection, recording, processing, storage and transfer of my personal data by the data controller Dr. Nur Cihan Coşansu Dermatology Clinic Ltd. Co. and its authorized personnel, in accordance with the applicable legislation.

In accordance with the Turkish Personal Data Protection Law No. 6698 and relevant regulations, I accept and declare that my personal data, sensitive personal data and health data, including identity and contact information, may be processed, stored and shared by Dr. Nur Cihan Coşansu Dermatology Clinic Ltd. Co.

Personal data include but are not limited to: name-surname, Turkish ID number, contact information (phone, address, email, IP address), social security number, tax number, signature data, camera recordings, photographs, biometric data and health information.

1- Processing, storage and transfer of my personal and sensitive personal data by Dr. Nur Cihan Coşansu Dermatology Clinic Ltd. Co.

I approve.      I do not approve.

2- Transfer of my data to domestic or international suppliers (accountants, legal advisors, IT providers, etc.) limited to the service provided

I approve.      I do not approve.

3- Transfer to healthcare institutions for second medical opinion purposes

I approve.      I do not approve.

4- Transfer to private insurance companies for authorization and billing procedures

I approve.      I do not approve.

5- Processing and storage of medical photographs taken during treatment

I approve.      I do not approve.

6- Receiving appointment and campaign notifications via email, SMS or phone

I approve.      I do not approve.

7- Transfer of my health data abroad for consultation or laboratory services

I approve.      I do not approve.

Patient / Legal Representative Information

Full Name :

Date :

Signature :

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