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Can Hastanesi

Explicit Consent Form for Personal Data Processing

İzmir Özel Can Hastanesi

This translation is provided for information only; the Turkish version is legally binding.

Document code
HE.FR.04
Publication date
01/02/2021
Revision
00

Page 1/2 · Consent to data processing and communication

Doc. Code: HE.FR.04 · Publication Date: 01/02/2021 · Rev. No/Date: 00

Dear data subject,

As Sardes Özel Sağlık Hizmetleri Ticaret Anonim Şirketi (the “Company”), in our capacity as Data Controller, we process, store and transfer your health data and certain other personal data within the scope of the Privacy Notice on the Processing of Personal Data and the Personal Data Protection Law, on the grounds that this is required for the performance of a contract, is expressly provided for by law, is mandatory for the establishment, exercise or protection of a right, is mandatory for our legitimate interests and is mandatory for us to fulfil our legal obligations. Pursuant to Article 11 of the KVKK, you may submit your requests concerning these personal and special category data, such as obtaining information, erasure, destruction, rectification, objection and compensation for damages, in person to the address “8019/16 Sok. No:18 Çiğli/İZMİR”, send them through a notary public or by registered mail with return receipt, or send them electronically, signed with a secure electronic signature, to sardesozelsaglik@hs.03.kep.tr with the note “Request for Information under the Personal Data Protection Law”.
Where necessary, you may also contact our legal entity via the e-mail address resmi.islemler@izmircanhastanesi.com and the telephone line +02327154000. You can access the Privacy Notice on the Protection and Processing of Personal Data and the Personal Data Protection Application Form here.
By ticking the consent boxes, you will have consented to our company, which provides health services, processing your identity data, contact data, financial data, health data and genetic data such as voice and image recordings that you provide in connection with your health data, for the specified purposes and reasons, and transferring them to recipient groups for the purposes set out below.

In addition, although services can be provided with respect to the matters set out below, we request your explicit consent because adequate service cannot be provided to you with respect to the following matters, which require explicit consent under the KVKK and the GDPR. You have the right to refuse this matter for which your explicit consent is requested. Dear patient, you may withdraw your consent at any time.

I declare that, in order for services to be provided more efficiently for the benefit of patients, I consent to e-mails, post and SMS messages being sent to me and to my being informed by telephone for the conduct of marketing operations, including for communication purposes, and in this context for processing, use and storage for all kinds of information, informative promotion and other purposes and for the planning, execution or reporting of processes; to my personal data processed for these purposes being used, shared and stored for the necessary period, limited to the purpose of processing within the scope of the relevant process; that the necessary information has been provided to me in this regard; and that I have read and understood this text and the Privacy Notice on the Protection and Processing of Personal Data;

Please write in your own handwriting and sign the sentence “I am informed about the matters explained above and, in this context, I consent to the processing of my personal data with my informed explicit consent and of my own free will”.

Page 2/2 · Processing of health and genetic data

Doc. Code: HE.FR.04 · Publication Date: 01/02/2021 · Rev. No/Date: 00

Dear data subject,

As Sardes Özel Sağlık Hizmetleri Ticaret Anonim Şirketi (the “Company”), in our capacity as Data Controller, we process, store and transfer your health data and certain other personal data within the scope of the Privacy Notice on the Processing of Personal Data and the Personal Data Protection Law, on the grounds that this is required for the performance of a contract, is expressly provided for by law, is mandatory for the establishment, exercise or protection of a right, is mandatory for our legitimate interests and is mandatory for us to fulfil our legal obligations. Pursuant to Article 11 of the KVKK, you may submit your requests concerning these personal and special category data, such as obtaining information, erasure, destruction, rectification, objection and compensation for damages, in person to the address “8019/16 Sok. No:18 Çiğli/İZMİR”, send them through a notary public or by registered mail with return receipt, or send them electronically, signed with a secure electronic signature, to sardesozelsaglik@hs.03.kep.tr with the note “Request for Information under the Personal Data Protection Law”.
Where necessary, you may also contact our legal entity via the e-mail address resmi.islemler@izmircanhastanesi.com and the telephone line +02327154000. You can access the Privacy Notice on the Protection and Processing of Personal Data and the Personal Data Protection Application Form here.
By ticking the consent boxes, you will have consented to our company, which provides health services, processing your identity data, contact data, financial data, health data and genetic data such as voice and image recordings that you provide in connection with your health data, for the specified purposes and reasons, and transferring them to recipient groups for the purposes set out below.
Through its health service system, our Company creates appointment records by also sharing your identity information and health data with physicians. Although this is a preventive health activity, your explicit consent is required for your health data, which we will process, retain and transfer to physicians as required by our contractual relationship because we provide health services, and for the genetic data you provide in connection with your health data. We would therefore like to point out that, if you do not give your consent regarding the health data and the genetic data connected with your health data for which your explicit consent is requested in this form, it will be impossible to provide health services to you, that is, to perform the contract. In order to serve you better and to continue our contractual relationship, we need to process your identity, contact, health and genetic data.
I declare that I consent to my personal health data, including special category and genetic data, processed for the purposes stated above being used, limited to the purpose of processing within the scope of the relevant process and contractual relationship, shared with physicians and the relevant institutions and organisations, and stored for the necessary period; that the necessary information has been provided to me in this regard; and that I have read and understood the Privacy Notice on the Protection and Processing of Personal Data;

Please write in your own handwriting and sign the sentence “I am informed about the matters explained above and, in this context, I consent to the processing of my personal data with my informed explicit consent and of my own free will”.

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