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Explicit Consent Form of Patient/Patient Relative Regarding the Processing of Personal Data

ANNEX 1.2.5. EXPLICIT CONSENT FORM OF PATIENT/PATIENT RELATIVE REGARDING THE PROCESSING OF PERSONAL DATA

Article 1. Personal Data:

According to Article 3/1(d) of Law No. 6698 on the Protection of Personal Data (hereinafter referred to as the Law), personal data means any information relating to identified or identifiable natural persons.

Your personal data is collected and processed in accordance with the Law and relevant legislation; based on customer (patient/patient relative) declarations, through our suppliers, call center, company employees, and systems verbally, in writing, or electronically.

The protection, processing, and transfer of your personal data shared with Maltepe Görüntüleme ve Sağlık Hizmetleri Sanayi ve Ticaret A.Ş. (“Radiologica”) will be carried out within the scope of the Law and related legislation. This Explicit Consent Form, concluded pursuant to the Law, is an annex and an inseparable part of the Service Agreement concluded or to be concluded with the customer (patient/patient relative).
 

Article 2. Processing and Transfer of Personal Data:

Pursuant to Articles 5/2 and 6/3 of Law No. 6698 on the Protection of Personal Data, explicit consent is requested regarding the processing of personal data and special categories of personal data listed below, which do not fall under the conditions of processing without explicit consent.

A. The customer consents to the processing of special personal data such as marital status, blood type, and religion, contained in old-type ID card/driving license photocopies taken for the purpose of fulfilling the service agreement and related legal obligations, and to the transfer of this data, if necessary, to third real/legal persons domestically and abroad.  

Yes                             No 

B. The customer consents to the processing, within the period specified in the relevant legislation, of personal data obtained during the negotiations for establishing the service agreement, even if no agreement is concluded and the service is not provided; for the purposes of informing about new projects and services, and notifying about service campaigns, and if necessary, to the transfer of such data to third real/legal persons domestically and abroad.  

Yes                         No      


The customer acknowledges and undertakes that they have read and examined the Customer Information Text regarding the Protection and Processing of Personal Data of our Company.

You can submit your applications and requests within the scope of the Law by filling out the “Application Form pursuant to the Law on the Protection of Personal Data” available on the website “https://radiologica.com.tr/”;

  • Deliver it personally or via Notary to the address: Cevizli Mahallesi Fil Yokuşu Sokak No: 22/ Maltepe ISTANBUL,
  • Or send it to the email address xxxxx@hs03.kep.tr with secure electronic signature or mobile signature, via registered electronic mail (KEP), or to kvkk@radiologica.com.tr using the email address previously notified to the data controller and registered in the data controller's system by the relevant person.

 

Explicit Consent Form of Patient/Patient Relative Regarding the Processing of Personal Data