EXPLICIT CONSENT FORM ON THE PROCESSING OF PERSONAL DATA

In accordance with the Law No. 6698 on the Protection of Personal Data No. 6698 by ARVAS HEALTH SERVICES TRADE LTD.ŞTİ and the Regulation on the Processing of Personal Health Data and Ensuring the Privacy of Personal Health Data, your personal data included in the Patient / Service Area Clarification Text within the Scope of Protection of Personal Data submitted to your information in accordance with its relevant provisions; We request your explicit consent regarding the following matters, except for the processing and transfer of your personal data to the extent necessary for the protection of public health, medical diagnosis, examination, treatment and care services;

  1. Collection and Processing of Personal Data:

In order to provide me with quality service, I have been informed that you obtain my personal data verbally, in writing, visually or electronically, depending on the nature of the service provided, by reading the Patient / Service User Clarification Text within the Scope of Protection of Personal Data.

In this context, my general and special categories of personal data, 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;

  • Identity Information: My name, surname, Turkish ID number, copy of my driver’s license, passport number or temporary Turkish ID number, place and date of birth, marital status, gender, insurance or patient protocol number and other identification information that can identify me.
  • My Contact Information: My address, telephone number, e-mail address and other contact data, my voice call records kept by customer representatives or patient services in accordance with call center standards, and my personal data obtained when I contact the Hospital via e-mail, letter or other means.
  • My Financial Information: My bank account number, IBAN number, credit card information, billing information, and other financial data.
  • If I visit your hospital, the camera and photo records kept for security purposes, my vehicle license plate data if I use the parking and valet services, and related photo and camera records.
  • My visual and recorded data obtained from closed-circuit camera systems during my visit to your hospital.
  • My Health Information: My personal health data, including but not limited to all medical diagnoses, examinations, treatments, and care services, obtained and provided to you; such as my appointment and examination information, laboratory results, test results, check-up and prescription information, and the data specified in the consent form in case of medical intervention.
  • Survey, suggestion, satisfaction, appreciation, and complaint data; my browsing information obtained when I use your website and mobile applications; my IP address, Wi-Fi information, browser information, and any medical documents, surveys, related records, and forms or other data I share with you through other means, my private health insurance data and other data for the financing and planning of health services.
  1. Purposes of Processing Personal Data:

I have been informed that my General and Special Categories of Personal Data mentioned above can be processed for the following purposes;

  • Fulfilling the legal obligations stipulated in the Basic Law on Health Services No. 3359, Decree Law No. 663 on the Organization and Duties of the Ministry of Health and its affiliated institutions, the Public Health Law No. 1593, the Patient Rights Regulation, the Private Hospitals Regulation, the Regulation on Personal Health Data, and other related regulations;
  • Protecting public health, performing preventive medicine, medical diagnosis, treatment, and care services, planning and managing health services and their financing;
  • Providing you with information regarding your appointment if you have made one; Verifying your identity, preparing invoices, and ensuring that your procedures are planned, managed, and monitored accurately and quickly;
  • Financial reconciliation with contracted institutions regarding the health services provided to you responding to the requests of public institutions and organizations in accordance with the legislation
  • Measuring patient satisfaction and increasing patient satisfaction after you receive health services; Responding to all your questions and complaints; Informing you about the services provided;
  • Development of quality processes and fulfillment of activities;
  • Research and analyze the use of healthcare services in order to improve the services provided by you,
  • Participation in campaigns and providing campaign information by the relevant departments through all kinds of communication,
  • Measuring the satisfaction of patients receiving health services from your hospital and increasing patient satisfaction,

For these purposes, my personal data will be processed, recorded, stored, preserved, classified, and in case of issues related to public security and legal disputes, it will be transferred to public institutions and organizations, judicial bodies, the Population Directorate, the Turkish Medical Association, and the Turkish Pharmacists Association, and other relevant public officials, or to third parties such as your contracted laboratories, health institutions, insurance companies, law offices, financial consultants, and consultants as required by law and when necessary, with my consent.

  1. Methods of Collecting Personal Data and Legal Reasons:

I am aware that the legal reason for collecting my personal data is based on the Law on the Protection of Personal Data No. 6698, the Basic Law on Health Services No. 3359, the Decree Law No. 663, the Private Hospitals Regulation, and related legislation.

My personal data that I have shared in the Clarification Text, (i) is clearly stipulated by law, (ii) it is necessary to process the personal data belonging to the parties to the contract, provided that it is directly related to the establishment or performance of the contract, (iii) it is de facto impossible (i) it is explicitly stipulated by law, (ii) it is necessary to process personal data belonging to the parties to the contract, provided that it is directly related to the establishment or performance of a contract, (iii) it is mandatory for the protection of the life or physical integrity of the person himself or someone else who is unable to disclose his consent due to actual impossibility or whose consent is not legally valid, (iv) it is mandatory for the data controller to fulfill its legal obligation, (v) it is mandatory for the legitimate interest of the data controller, provided that it does not harm the fundamental rights and freedoms of the data subject, (vi) for the protection of public health, preventive medicine, medical diagnosis, treatment and care services, planning and management of health services and financing; Within the scope of the purposes specified in the Clarification Text;

  1. a) To be in compliance with the law and good faith,
  2. b) Provided that it is accurate and, where necessary, up to date,
  3. c) For specific, explicit and legitimate purposes,
  4. d) In connection with, limited and proportionate to the purpose for which they are processed,
  5. e) I have been informed that they will be processed, recorded, stored, maintained, classified and transferred by automatic means (for example, camera recordings) or non-automatic means (for example, forms filled out by me) provided that they are part of any data recording system (for example, forms filled out by me) in order to be kept for the period stipulated in the relevant legislation or for the period required for the purpose for which they are processed.

In addition, as stipulated in Article 6, paragraph 3 of the Law, I am aware that personal data related to health and sexual life can only be processed without my explicit consent for the protection of public health, preventive medicine, medical diagnosis, treatment and care services, and the planning and management of health services, by persons or authorized institutions and organizations who are under an obligation of confidentiality.

4.Transfer of Personal Data:

My Personal Data may be transferred to the Ministry of Health, sub-units and centers affiliated to the ministry, sub-units and centers affiliated to the ministry, sub-units and centers affiliated to the ministry, sub-units and centers affiliated to the ministry, sub-units and centers affiliated to the ministry, sub-units and centers affiliated to the ministry, within the framework of the Basic Law on Health Services No. 3359, the Decree Law No. 663 on the Organization and Duties of the Ministry of Health and its Affiliated Organizations, the Public Hygiene Law No. 1593, the Patient Rights Regulation, the Private Hospitals Regulation, the Regulation on the Processing of Personal Health Data and the Protection of Privacy and the Ministry of Health regulations and the relevant legislation provisions and for the purposes described above;

  • Ministry of Health, sub-units and centers affiliated to the ministry,
  • Turkish Medical Association,
  • Pharmacists Association of Turkey,
  • General Directorate of Population,
  • General Directorate of Security and other law enforcement agencies,
  • Social Security Institution,
  • Prosecutors’ offices, courts and all kinds of judicial authorities as required by the legislation,
  • Authorized public institutions and organizations to provide information to relevant public officials,
  • Laboratories, health institutions and organizations with which you cooperate for medical diagnosis and treatment, and relevant health institutions and organizations in case of referral,
  • I know that it can be transferred to all private insurance companies, law offices, financial advisors, business partners and all your consultants within the third parties you receive consultancy from.

5.Your Rights Regarding the Protection of Personal Data:

By approving this Clarification Text in accordance with the Law and relevant legislation;

  • To learn whether my personal data is being processed,
  • Request information regarding the processing of my personal data,
  • Access to and request for my personal health data,
  • To learn the purpose of processing my personal data and whether they are used for their intended purpose,
  • To know the third parties to whom my personal data is transferred domestically or abroad,
  • To request correction of my personal data in case of incomplete or incorrect processing,
  • To request the deletion or destruction (anonymization) of my personal data,
  • In case my personal data is incomplete or incorrectly processed, to request that third parties to whom personal data is transferred be notified of the transactions regarding the correction of these and/or the deletion or destruction of my personal data,
  • To object to the emergence of a result against you by analyzing my data processed by the hospital exclusively through automated systems,
  • In case of damage due to unlawful processing of my personal data, to demand the compensation of the damage

I was informed by ARVAS SAĞLIK HİZMETLERİ TİCARET LTD.ŞTİ that I HAVE THE RIGHTS.

6.Contact and Application;

I can submit my requests within the scope of the Law by filling out the “Application Form in accordance with the Law on the Protection of Personal Data” available at www.quartz.com.tr;

  • Fulya Mah. 19 Mayıs Cd. No: 8/B, 34360 Şişli/Istanbul address in person,
  • I can send it through a notary,
  • Fulya Mah. 19 Mayıs Cd. No: 8/B, 34360 Şişli/İstanbul address with secure electronic or mobile signature, I know that I can forward it to ARVAS SAĞLIK HİZMETLERİ TİCARET LTD.ŞTİ in writing or by using the registered electronic mail (KEP) address, secure electronic signature, mobile signature or the electronic mail address previously notified to the data controller by the data subject and registered in the system of the data controller.
  • I know that I will share my personal data that will be subject to processing with you as the personal data owner through all the contact information I have provided to you (Address, Telephone, Electronic mail, address, and other ……. contact means), that the feedbacks to be made can be made by you as the data controller through the same means of communication, and that if the relevant contact information changes, I will update it by informing you as the Data Controller.

Conclusion

I have read and understood the Patient / Service Area Clarification Text within the Scope of the Law on the Protection of Personal Data prepared by ARVAS SAĞLIK HİZMETLERİ TİCARET LTD.ŞTİ and the purpose of processing my personal data contained in this text; I have been informed about the institutions, organizations and companies and third parties to which it is transferred, the methods of collection and the legal reasons for them, my rights to protect my personal data, the security of my personal data and my right to apply,

My Personal and Special Qualified data; Except for the execution of the contract, explicitly stipulated in the law, (ARVAS HEALTH SERVICES TRADE LTD. ŞTİ is mandatory for the fulfillment of its legal obligation and for the purposes of protecting public health, preventive medicine, medical diagnosis, treatment and care services, planning and management of health services and financing, processing and transferring to the extent necessary for the purposes of planning and management of health services and financing, in accordance with the matters specified in the Patient / Service Area Clarification Text within the scope of the Law on the Protection of Personal Data; Processing, preservation, regulation and transfer,

AÇIK RIZAM ile KABUL EDİYORUM.

I ACCEPT WITH EXPRESS CONSENT.

PATIENT / SERVICE RECIPIENT

NAME FULL NAME

“I have read and understood” in handwriting

SIGNATURE, DATE, TIME

PATIENT / SERVICE RECIPIENT’S RELATIVE, if available

NAME FULL NAME

“I have read and understood” in handwriting

SIGNATURE, DATE, TIME

 

INTERPRETER when required to be present

NAME SURNAME

DATE, TIME, SIGNATURE