In order to carry out the services we will provide to you as ……………………………………………….., we may need to learn your personal information and health data and record and store them within the limits required by the service to be provided.
Your health data, which we have to record in order to provide you with health services, is considered special personal data by law. In this context, in accordance with the provision in the 2nd paragraph of Article 6 of the Personal Data Protection Law No. 6698, 'It is prohibited to process special personal data without the express consent of the person concerned.' Since personal health data can only be recorded with the express written consent of the person, except for the special conditions specified in the law. , you are obliged to obtain this consent.
Information Text
1. This consent covers the personal data you provide to us verbally, in writing, visually or electronically during our examination, and the personal data you transmit to us via internet and mobile applications or electronically or obtained in our practice.
2. In this sense, your name, surname, TR ID number, (if you are not a Turkish citizen, your passport number or temporary TR ID number), place and date of birth, marital status, especially the personal health data required to carry out the services we will provide to you and obtained for this purpose. , your identity data such as your gender information and various identity documents, your contact data such as your address, telephone number, e-mail address, your financial data such as your bank account number, IBAN number, your medical history in your clinic file, information showing your disease history, your examination data, information regarding the procedures applied to you. data, your health and sexual life data obtained during the execution of medical diagnosis, treatment and care services such as your prescription information, photographs, all kinds of images, audio/camera recordings, laboratory and imaging results, test results, your data regarding private health insurance and Social Security Your institution data etc. is considered personal data.
3. These personal data of yours will be recorded only to the extent required by the health service to be provided to you, within the framework of the Personal Data Protection Law No. 6698 and relevant legislation, and will be stored in our system/archive '...not to exceed the period necessary to achieve the purposes of recording'. In this context, your data processed will be protected as a professional secret, confidentiality will be ensured and will not be shared by third parties/institutions/organizations.
4. However, in cases where the confidentiality of personal medical records must be limited for the protection of public health, such as the obligation to notify the competent authorities of infectious diseases regulated in Article 58 of the General Hygiene Law No. 1593, or in cases of legal obligation such as the obligation to report a crime, it may be processed only for a limited purpose. We would like to remind you that it may be necessary to notify the competent authorities in a reasonable and proportionate manner.
5. Requests from public institutions, judicial authorities and other official authorities to transmit your data to them, the purpose of the request, whether the requested data overlaps with the purpose to be achieved, whether it can be stated in concrete form, the necessity of transmitting your data without anonymization as the only way to achieve the stated purpose. , data transmission will be evaluated in terms of whether it is necessary in a democratic society or not, and data transmission requests that do not meet all of these elements will not be fulfilled.
6. Regarding your data recorded by us, in accordance with the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data (Council of Europe Convention No. 108), Article 8 of the European Convention on Human Rights, Article 20 of the Constitution, Personal Data Protection Law No. 6698:
• Learning whether your personal data is being processed and the scope of your processed data,
• If your personal data has been processed, obtaining information about it, accessing this data and taking samples from it,
• To learn the purpose of processing your personal data and whether they are used in accordance with their purpose, whether they are transferred to a third person or institution at home or abroad, and to request that changes in your personal data be notified to the persons or institutions with whom the data is shared,
• Requesting correction of your personal data if it is incomplete or incorrectly processed, (This right…………………………………………………………………………………………… …………………………………………………………………………………………………………………………………. .by applying in person or in writing to our full address hospital/office address or by sending a message to our e-mail address ……………………………….. was informed about)
• You have the right to request that some of your data be hidden, deleted, anonymized or destroyed.
II. DECLARATION OF CONSENT
……………………………………………. I have read and understood the Personal Data Disclosure and Consent Text prepared by, and I have also been given verbal information regarding the subject,
I have been informed about the purposes of processing of my personal data, collection methods and legal reasons, my rights to protect my personal data, mandatory circumstances in which my data may be transferred, data security and application rights, which are detailed in the Personal Data Information and Consent text,
All my personal data, including my health data, are …………………………………………………… within the framework of the above principles. and its employees to be recorded, stored, and shared in the mandatory cases listed,
In addition, …………………………………………………….. and its employees;
• Written and verbal via mobile devices (phone:………………………………...),
• In writing and verbally over the internet (e-mail address:………………………………..) or
• I ACCEPT WITH MY EXPLICIT CONSENT that my address (address:………………………………………………………………..by mail etc.) can be reached. *As per the Patient Rights Regulation; form 1 A copy will be given to you. If the form is not given to you, please notify the person who received the approval.
Patient Name and Surname………………………………………………………
Signature:…………Date: ……./……./………Time:…..
If the patient is under 18 or unconscious:
Patient Relative Name and Surname:………………………………………..
Signature:…………Date: ……./……./………Time:…..
The degree of proximity: …………………………..
Write “I understood what I read” in your own handwriting:……………………………………………………………………..
INTERPRETER IF ANY (If the patient has a language / communication problem)
In my opinion, the information I translated was understood by the patient/patient's relative.
Name and Surname of the Translator:……………………………….…….
Signature: …………Date: …../……./……… Time:……
