Except for the situations; to the extent necessary for the performance of the contract, clearly stipulated in the law, mandatory for us to fulfill our legal obligation and for the protection of public health, preventive medicine, medical diagnosis, treatment and care services, planning and management of health services and financing; we request your explicit consent regarding the following issues for processing and transfer of your personal data, which is detailed in the Clarification / Information text about the Processing of Personal Data by ImpOrth Smile Studio;

Collection, Processing and Processing Purposes of Personal Data

In order to provide me with high standards of service, I have been informed by reading the Clarification / Information text about the Processing of Personal Data that you obtain my personal data verbally, in writing, visually or electronically from Call Center, internet, mobile applications, physical places and similar channels depending on the nature of the service provided.

In this context, my main general and special personal data obtained, especially my personal health data required for the execution of all medical diagnosis, examination, treatment and care services and obtained for this purpose, are listed below;

•          My identity data such as my name, surname, TR ID number, passport number or temporary TR ID number in case I am not a Turkish citizen, place and date of birth, gender information and my TR ID Card or Driving License photocopy I submitted,

•          My contact data such as my address, phone number, e-mail address,

•          My financial data such as my bank account number, IBAN number,

•          My health and sexual life data obtained during the execution of medical diagnosis, treatment and care services such as my laboratory and imaging results, test results, examination data, and prescription information that I have presented myself for follow-up in my file,

•          Responses and comments I have shared in order to evaluate your services,

•          My closed circuit camera system video and audio recording taken during my visit to your hospitals,

•          Voice call records kept if I contact your Call Center,

•          My data on private health insurance and Social Security Institution for the purpose of financing and planning the health services,

•          My license plate data if I benefit from parking and valet service,

•          My navigation information, IP address, browser information obtained during the use of your website and medical documents, surveys, form information and location data which I voluntarily sent,

•          Information I provided during my job application

I have been informed that my personal data listed above and my special personal data may be processed for the following purposes;

•          Execution of public health protection, preventive medicine, medical diagnosis, treatment and care services,

•          Sharing the requested information with the Ministry of Health and other public institutions and organizations in accordance with the relevant legislation,

•          Fulfillment of legal and regulatory requirements,

•          Financing your health services, meeting your examination, diagnosis and treatment expenses by the Patient Services, Financial Affairs, Marketing departments, sharing the information requested with private insurance companies within the scope of the deserving query,

•          To be informed about my appointment by your Call Center and Digital Channels,

•          Confirming my identity by Patient Services, Your Health Professionals and Call Center departments,

•          Planning and managing the internal functioning of the institution by the Hospital Management,

•          Performing analysis for the purpose of improving health services by Quality, Patient Experience, Information Systems departments,

•          Providing training to our employees by Human Resources and Quality departments,

•          Monitoring and preventing abuse and unauthorized transactions, by Audit and Information Systems departments,

•          Carrying out risk management and quality improvement activities by the Departments of Quality, Patient Experience, Information Systems,

•          Invoicing for your services by Patient Services, Financial Affairs, Marketing departments,

•          Confirmation of my relationship with the institutions contracted with your hospital by Patient Services, Financial Affairs, Marketing departments,

•          Responding to all kinds of questions and complaints about health services given/to be given to me by Hospital Management, Patient Experience, Patient Rights, Call Center departments,

•          Taking all necessary technical and administrative precautions within the scope of data security of the systems and applications of your hospital by the Hospital Management, Information Systems departments,

•          Providing campaign participation and campaign information, designing and transmitting special contents, tangible and intangible benefits on web and mobile channels, by the Departments of Marketing, Media and Communication, Call Center,

•          Measuring, increasing and researching patient satisfaction by the Hospital Management, Patient Rights, Patient Experience departments,

•          To be able to carry out education and teaching activities by the educational institutions in which the institution cooperates.

I have been informed in detail that my “Personal and Sensitive Data” mentioned above can be kept within ImpOrth Smile Studio and external service providers in physical and electronic archives with great care and in compliance with the provisions of the legislation.

Transfer of Personal Data

My personal data can be shared within the framework of the Basic Law on Health Services No. 3359, the Decree Law on the Organization and Duties of the Ministry of Health and its Affiliates No. 663, the Law on the Protection of Personal Data No. 6698, the Regulation on Private Hospitals, the Regulation on Processing and Privacy of Personal Health Data and the regulations of the Ministry of Health and other legislation provisions and for the purposes described above;

•          Ministry of Health, subunits affiliated to the ministry and family medicine centers,

•          Private insurance companies (health, retirement, life insurance, etc.),

•          Social Security Institution,

•          General Directorate of Security and other law enforcers,

•          With the General Directorate of Census,

•          Turkey Pharmacists Association,

•          Judicial authorities,

•          The laboratories, medical centers, ambulances, medical devices and the institutions providing health services that you cooperate with in the country or abroad as ImpOrth Smile Studio for medical diagnosis and treatment,

•          Another health institution which I myself have applied or to which I have been dispatched, in the event that I am dispatched,

•          The legal representatives I have authorized,

•          The third parties you have consulted, including the lawyers, tax consultants and auditors you work with,

•          Regulatory and supervisory institutions and official authorities,

•          The systems in Turkey or abroad and/or the branches within the group of companies to which our Hospital is affiliated,

•          My employer in the event that my invoicing is to be made to the employer,

•          Suppliers, support service providers, archive service providers and business partners you cooperate with as a company (I know that I can get information by contacting your hospital in writing for more detailed information).

Method and Legal Background of Collecting Personal Data

I have been informed that my personal data is being collected and processed in order to carry out all kinds of works within the legal framework and in this context for ImpOrth Smile Studio to fulfill the contractual and legal obligations in full and proper manner in all kinds of verbal, written, visual or electronic media, for the purposes stated above and for the activities of ImpOrth Smile Studio.

The legal reason for collecting my personal data is;

•          Law on Protection of Personal Data No. 6698,

•          Fundamental Law of Health Services No. 3359,

•          Decree Law No. 663 on the Organization and Duties of the Ministry of Health and its Affiliates,

•          Private Hospitals Regulation

•          Regulation on the Processing of Personal Health Data and Protection of Privacy,

•          Regulations of the Ministry of Health and other legislation provisions.

In addition, as stated in Article 6, paragraph 3 of the Law, personal data relating to health and sexual life may be processed without my explicit consent by the people or authorizied institutions and organizations with an obligation of confidentiality only for the purpose of protecting public health, preventive medicine, medical diagnosis, treatment and care services, health care and financing planning and management.

Your Rights for the Protection of Personal Data

In accordance with the Law and relevant legislation;

•          To learn whether my personal data is processed or not,

•          To request information regarding the personal data if they are processed,

•          To access and request my personal health data,

•          To learn the purpose of processing my personal data and whether they are used for their intended purpose or not,

•          To know about the third parties to whom my personal data are transferred domestically or abroad,

•          To request correction of my personal data in case of incomplete or incorrect processing,

•          To request the deletion or destruction of my personal data,

•          To request notification of the third parties to whom my personal data has been transferred, regarding the correction and/or the deletion or destruction of my personal data in case of incomplete or incorrect processing,

•          To object to the emergence of a result against myself by menas of analyzing my processed data exclusively through automated systems,

•          To request claim in the event that I suffer damage due to the illegal processing of my personal data,

I have been informed that I have the rights.

By filling in the Personal Data Protection Law Application Form at the web address; ” www.importhsmilestudio.com”; I know that I can

I ACCEPT with MY EXPLICIT CONSENT;

I read and understood the Clarification/ Information About the Processing of Personal Data text prepared by ImpOrth Smile Studio,

I have been informed about the purposes of processing my personal data in detail in the Clarification of Protection and Processing of Personal Data text, the institution, organization, company and health professionals to whom it is transferred, collection methods and legal reasons, my rights for the protection of my personal data, data security and my right to appeal,

The preservation, processing and transfer of my personal and special data in accordance with the matters specified in the Clarification/ Information text about the Processing of Personal Data, except for the performance of the contract, its explicit stipulation in the law, the mandatory status of ImpOrth Smile Studio for fulfilling its legal obligation and the protection of public health, the execution of preventive medicine, medical diagnosis, treatment and care services, the planning and management of health services and their financing, processing and transfer to the extent necessary.

* According to the Patient Rights Regulation; 1 copy of the form will be given to you. Notify if the form is not given to you.

CONSENT

Please write “I understood what I read” in your own handwriting: ……………………………………………………………………

Patient’s Full Name: ………………………… Signature: ……… Date: …../……/……  Time: …………

Relative’s Name & Surname: …………………………  Signature: …………  Date: ……/…../……..  Time: ………..

The degree of proximity: …………………………

Reason for Obtaining Consent from the Patient’s Relatives:

•          If the patient is under the age of 19 (Signatures are obtained from both parents – mother and father. However, if the family is divorced, the signature is taken from the custodial parent)

•          Does not have the power to appeal / does not have the ability to make decisions (Signature is obtained from his guardian or legal representative)

•          Unconscious patient

INTERPRETER (If the patient has a language / communication problem)

According to my opinion, the information I translated was understood by the patient/patient’s relative.

Interpreter’s Name & Surname:……………..  Signature: ………….  Date: ……./……/…….   Time:……………..