CORPORATE

Patient / Patient Relative Informed Consent Form

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

Article 1. Personal Data:

According to Article 3/1(d) of the Personal Data Protection Law No. 6698 (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 verbally, in writing, or electronically through our suppliers, call center, company employees, and systems, based on customer (patient/patient relative) statements, in accordance with the Law and relevant legislation.

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 relevant legislation. This Explicit Consent Form, concluded pursuant to the Law, is an annex and an integral part of the Service Agreement made or to be made with the customer (patient/patient relative).

Article 2. Processing and Transfer of Personal Data:

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

A. The customer consents to the processing of their personal data regarding marital status, blood group, and religion, which are special categories of personal data found on old-style identity card/driving license photocopies taken for the purpose of performing the service contract and fulfilling obligations arising from relevant legislation, and to the transfer of such data, if necessary, to domestic and foreign third real/legal persons.

Yes                                                          No

B. The customer consents to the processing of personal data obtained during the service contract negotiations, even if no contract is concluded and the service is not realized, limited to the duration specified in the relevant legislation, for the purpose of informing about new projects and services and notifying about service campaigns, and to the transfer of such data, if necessary, to domestic and foreign third real/legal persons.

Yes                                                          No

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

You can submit your applications and requests under the Law by filling out the “Application Form Pursuant to the Personal Data Protection Law” available at https://radiologica.com.tr/;

  • By delivering it personally or via a notary to the address: Cevizli Mahallesi Fil Yokuşu Sokak No: 22/ Maltepe ISTANBUL,
  • By sending it securely with an electronic or mobile signature via registered electronic mail (KEP) to the address xxxxx@hs03.kep.tr, or by sending it to kvkk@radiologica.com.tr using the email address previously notified to the data controller and recorded in the system by the relevant person.

 

Patient / Patient Relative Informed Consent Form