Confidentiality Agreement

EXPRESS CONSENT DECLARATION FORM OF THE DATA SUBJECT

To the  Doctor Sezgin Öztürk (will be briefly described as a physician/Clinic  below) at İsmet Kaptan Mah. Şevket Özçelik Sok No:57/B Kat:3 D:301 Konak -İZMİR and to with which he cooperates,  I accept, declare and undertake that I have read the Enlightenment/Information Letter of In accordance with the “Law on the Protection of Personal Data” numbered 6698 , GDPR (General Data Protection Regulation)  and the “Regulation on the Processing and Privacy of Personal Health Data”, the processing of my personal data, special quality personal data, health data, and those who identify or serve to determine my identity, given by me verbally/written and/or electronically. My contact information from my Personal Data, which I consent to the processing of all kinds of personal data, including the Enlightenment Text; To be processed by the clinic and physician in order to carry out my examination, preventive medicine, medical diagnosis, treatment, care and control services, to improve the medical treatment practice applied to me, to remind my appointment dates for continuous treatments and to be personally informed about the innovations regarding medical treatment and applications, In order to inform about innovations and developments in services, to remind the appointment dates for continuous treatments, and to send sms, e-mails and mobile communication to me for celebration and congratulation on special days, to provide health services and to plan these services, sharing is required within the scope of the relevant legislation. to be shared with other individuals and organizations; I accept, declare and consent to the processing of personal and special quality personal data, the details of which are given below, within the scope defined in the “Personal Data Protection Law” No. 6698 and the “Regulation on the Processing and Privacy of Personal Health Data” I promise.

 

Clearly belonging to an identified or identifiable natural person; processed partially or fully automatically or non-automatically as part of the data recording system; data that contains information about the identity of the person; Documents such as driver’s license, identity card and passport containing information such as name-surname, T.R. ID number, nationality information, mother’s name-father’s name, place of birth, date of birth, gender, tax number, SGK number, signature information, etc. informations

 

  • Clearly belonging to an identified or identifiable natural person; partially or

processed completely automatically or non-automatically as part of a data recording system; information such as telephone number, address, e-mail address, fax number, IP address

  • Clearly belonging to an identified or identifiable natural person; processed partially or fully automatically or non-automatically as part of the data recording system; Personal data regarding the records and documents taken at the entrance to the physical space, during the stay in the physical space; camera records, fingerprint records and records taken at the security point
  • Clearly belonging to an identified or identifiable natural person; photographs and camera recordings (excluding the records included in the Physical Space Security Information), data contained in documents that are copies of documents containing personal data
  • Clearly belonging to an identified or identifiable natural person; processed partially or fully automatically or non-automatically as part of the data recording system; Data specified in Article 6 of the Personal Data Protection Law (eg health data including blood group, biometric data, etc.)
  • Clearly belonging to an identified or identifiable natural person; Personal data related to the receipt and evaluation of all kinds of requests or complaints directed to the clinic and physician, which are processed partially or completely automatically or non-automatically as a part of the data recording system

I have read and accept the Clarification/Information text and my rights on the Protection and Processing of Personal Data by the Clinic, both from the website of the Clinic and / or physically.

In case it is determined that the personal data I shared with the Clinic and the Physician have been obtained without the explicit consent of the owner and/or unlawfully: Sanctions will be imposed by the relevant 3rd parties, data owners or the Personal Data Protection Board and other administrative and judicial bodies before the Clinic and the Physician, and and in case of any damage to the doctor due to this reason, it is my responsibility to indemnify all kinds of penal, legal and all kinds of damage, that I have read and examined the clarification/information text of the clinic and that I know, understand and accept all the stated issues, that my personal data is within the scope defined in the Law on the Protection of Personal Data numbered 6698 with my free will. I accept, declare and undertake that I give express consent to its processing, use and transfer.