PATIENT / GUARDIAN INFORMATION AND CONSENT FORM REGARDING THE PROTECTION OF PERSONAL DATA
Dear Patient / Parent / Legal Guardian,
Pursuant to the Personal Data Protection Law No. 6698 (KVKK) and the Regulation on the Processing of Personal Health Data and Protection of Privacy No. 29863, the institution operating at the address specified in the original form acts as the “Data Controller”.
You have the ability to opt-out of receiving any promotional communications as desciribed below under “Your Choises.”
As the Data Controller, your personal data may be obtained, recorded, stored, preserved, modified, reorganized, disclosed, transferred, acquired, made available, classified, or prevented from being used, either fully or partially by automated means or by non-automated means provided that they form part of a data recording system, in accordance with KVKK and the relevant Regulation.
PURPOSES OF PROCESSING PERSONAL DATA
Your personal data may be processed for the following purposes:
• Protection of public health, preventive medicine, medical diagnosis, treatment, and care services.
• Planning and management of healthcare services and their financing.
• Preparation of all records and documents required for services provided electronically or in paper form.
• Transfer of information to the Ministry of Health of the Republic of Türkiye and other public institutions when legally required.
• Compliance with obligations arising from agreements concluded with public and private legal entities.
• Provision of requested services.
• Fulfillment of obligations arising from the legal relationship established with the recipient of services.
• Sharing information requested by private insurance companies within the scope of financing healthcare services.
PERSONS AND INSTITUTIONS TO WHOM DATA MAY BE TRANSFERRED
Personal data may be shared, where legally required, with:
Ministry of Health and its affiliated units, authorized representatives, private insurance companies, Social Security Institution, General Directorate of Security and other law enforcement authorities, General Directorate of Population and Citizenship Affairs, Turkish Pharmacists’ Association, courts and judicial authorities, lawyers, laboratories and medical centers cooperating in diagnosis and treatment, ambulance services, medical device providers, healthcare institutions, and suppliers to the extent necessary for the provision of services.
METHOD OF COLLECTING PERSONAL DATA AND LEGAL BASIS
Personal data may be collected through customer representatives, websites, mobile applications, social media accounts to which access is granted, and call centers by automated or non-automated means. The legal basis for such processing includes Law No. 6698 on the Protection of Personal Data, the Regulation on Private Hospitals, Law No. 3359 on Basic Health Services, the Regulation on the Processing of Personal Health Data and Protection of Privacy, Ministry of Health regulations, and other applicable legislation.
YOUR RIGHTS
You have the right to:
• Learn whether your personal data is being processed.
• Request information if your personal data has been processed.
• Learn the purpose of processing and whether it is used in accordance with that purpose.
• Know the third parties to whom your data has been transferred domestically or abroad.
• Request correction of incomplete or inaccurate data.
• Request deletion or destruction of data under the conditions prescribed by law.
• Request notification of such actions to third parties to whom the data has been transferred.
• Object to unfavorable outcomes arising from automated processing.
• Claim compensation for damages suffered due to unlawful processing of personal data.
DECLARATION AND CONSENT
I declare that the information contained in the Information and Consent Form regarding the Protection of Personal Data has been explained to me clearly, accurately, and comprehensibly.
□ Explained to me
□ Not explained to me
Unless I notify otherwise:
□ I CONSENT to the use of my personal data for marketing activities, informational messages, promotions, surveys, invitations, events, and communication activities, and to being contacted via SMS, e-mail, post, telephone, and other communication channels.
□ I DO NOT CONSENT.
Relatives Authorized to Receive My Personal Data:
______________________________________
Other Private Persons / Entities Authorized to Receive My Personal Data:
______________________________________
Patient and/or Parent / Legal Guardian
Full Name: __________________________
Signature: ___________________________
Date: ____ / ____ / 20____
