EXPLICIT CONSENT FORM FOR THE PROCESSING OF PERSONAL INFORMATION
Your personal data, is detailed in the Clarification Text prepared by Birkan Özkan Clinic within the scope of the Law on the Protection of Personal Data, except in cases where the performance of the contract is expressly stipulated in the law, it is necessary for us to fulfill our legal obligation and it is processed and transferred to the extent necessary for the protection of public health, preventive medicine, medical diagnosis, treatment and care services, planning and management of health services and financing; We request your explicit consent regarding the following matters;
COLLECTION, PROCESSING AND PROCESSING PURPOSE OF PERSONAL DATA
In order to provide quality service to me, I have been informed reading the Clarification Text issued within the scope of the Personal Data Protection Law that you have obtained my personal data verbally, in writing, visually or electronically from the Call Center, internet, mobile applications, physical places and similar channels depending on the quality of the service provided. In this context, the main general and special personal data obtained, especially my personal health data, which are necessary for the execution of all medical diagnosis, examination, treatment and care services and obtained for this purpose, are listed below;
-My identity data; Name, surname, Republic of Turkey ID number, passport or foreign identity number if any, date of birth, gender, marital status information, identity card, photocopy of passport or driver’s license, my insurance number and information
-My contact data; mobile phone number, e-mail address, residence address, workplace address
My personal data of special nature; Photograph on the identity card, passport or driver’s license, health data (laboratory and radiography imaging results, systemic disease information consent form, blood group, test results, examination information, prescription information, disease, alcohol and substance abuse information, pregnancy information for women, health data obtained during the execution of medical diagnosis, treatment and care services such as genetic health risk information), appointment and examination data, data in the consent form
-My Financial Data; Bank account number and IBAN information, credit card information, private health insurance data
-My working data; Occupation, title, workplace, department, working type data,
-My visual and audio data; Photographs, audio recordings, camera footage, video recordings
-My website/application usage data; Site activities, IP address, username
I have been informed that my personal data listed above and my personal data of special nature can be processed for the following purposes;
Correct application of medical diagnosis and treatment, Sharing the requested information with the Ministry of Health and other public institutions and organizations in accordance with the relevant legislation, Providing health services in accordance with the legislative framework, Maintaining and developing the Clinic practice activities, Making appointments and informing the patient about this issue, Increasing the quality of service, Supporting and communicating with the patient within the scope of the contract, Creating a contract, Controlling the contract, data and rights of the patient upon request and informing the patient, Creating and sending the invoice (E-invoice, E-archive, paper invoice) to the patient, Opening the patient’s record , creating, updating, deactivating the user name, management and control of the invoicing and payment process, fulfilling the work undertaken within the practice in accordance with the contract and laws, and in this context, Birkan Özkan Clinic in the contracts, Fulfilling the obligations arising from the law and the legislation fully and duly, Fulfilling the legal and regulatory requirements, Sharing the information requested with the private insurance companies within the scope of the question of plausibility, Monitoring and preventing abuse and unauthorized transactions by the practice, Health services given/to be provided to me by the practice In case of request and in accordance with the legislation; I have been informed in detail that it can be shared/transferred with,
– The Ministry of Health, sub-units of the ministry and family medicine centers.
– The Ministry of Health, sub-units and family medicine centers affiliated to the ministry,
– The Private insurance companies (health, retirement, life insurance, etc.),
– The Social Security Institution,
– The Turkish Pharmacists Association,
– The General Directorate of Population,
– The Judicial authorities and official authorities,
– Laboratories, medical centers, ambulances, medical devices and institutions providing health services in the domestic or abroad, in cooperation as a practice for medical diagnosis and treatment,
-In case of being referred, with another health institution to which I was referred or to which I applied myself,
-My legal representatives
– All my consultants within the scope of the third parties I get consultancy,
– The regulatory and supervisory institutions and official authorities.
I have been informed in detail that my “Personal and Private Data” mentioned above can be kept in physical and electronic archives in Birkan Özkan Clinic and external service providers with great care and compliance with the provisions of the legislation.
I kow that the legal reason for the collection of my personal data is within Personal Data Protection Law numbered 6698, Health Services Basic Law numbered 3359, Decree on the Organization and Duties of the Ministry of Health and its Affiliates numbered 663, Legislation on the Processing of Personal Health Data and Protection of Privacy, Legislation on Private Hospitals and other relevant legislation. Likewise, I know that it can be processed without my explicit consent by persons or authorized institutions and organizations that are under the obligation to keep secrets, as specified in the Law on the Protection of Personal Data, health and sexual life confidential only for the purposes of protecting public health, performing preventive medicine, medical diagnosis, treatment and care services, planning and managing health services and financing.
MY RIGHTS REGARDING THE PROTECTION OF PERSONAL DATA:
In accordance with the relevant laws and legislations;
-Learning whether my Personal Data is processed or not,
– If my Personal Data has been processed, requesting information about it and learning to whom it has been revealed,
-Learning the purpose of processing my Personal Data and whether they are used in accordance with its purpose,
-Knowing the Third Parties to whom my Personal Data is transferred, at domestic or abroad,
-Requesting correction of my Personal Data in case of incomplete or incorrect processing and notification of this correction to the Third Parties, if any, to which the data is transferred,
-Requesting the deletion or destruction of Personal Data in the event that the reasons for the processing of my Personal Data disappear within the framework of the conditions stipulated in the Personal Data Protection Law, and requesting that this be notified to the third parties, if any, to which the data is transferred (Since personal data within the scope of health is obliged to be kept within the scope of the legislation, the right to be deleted will be evaluated in accordance with the Regulation on the Processing and Privacy of Personal Health Data and will be sent to the central database.)
I have been informed that I have the rights about;
– Objecting to the processing of my Personal Data in case of a result against me,
-Requesting the compensation of the damage in case I suffer damage due to the unlawful processing of my Personal Data. In order to use my requests the scope of the Law and my rights stated above, I can fill out the Application Form on the website “ www.drbirkanozkan.com and submit it personally to the address (Limonluk Mah. İsmet İnönü Bulv. No:181/2 Yenişehir/MERSİN/TURKEY) specified in this Application Form. I know that I can send it through a notary public or send it to the “ www.drbirkanozkan.com e-mail address with a secure electronic signature.
I have read and understood the Clarification Text under the Law on the Protection of Personal Data prepared by Birkan Özkan Clinic, the purpose of processing my personal data, is detailed in the Clarification Text under the Law on the Protection of Personal Data, the institution, organization, company and health professionals that it is transferred, methods of collection and legal reasons, my personal data that I have been informed about my rights for the protection of data, data security and my right to apply, that my personal and private data; Performance of the contract, clearly stipulated in the law, mandatory for Birkan Özkan Clinic to fulfill its legal obligations and processing and transferring as necessary for the purposes of protecting public health, performing preventive medicine, medical diagnosis, treatment and care services, planning and management of health services and financing.
I AGREE WITH MY EXPLICIT CONSENT that it is processed, stored and transferred in accordance with the matters specified in the Clarification Text within the scope of the Data Protection Law