PATIENT EXPLICIT CONSENT TEXT

Subject: This is my explicit consent to the processing of my health data within the scope of the Personal Data Protection Law No. 6698 (KVKK).

Name-Surname: ………………………………………………
T.C. Identity Number: ………………………………………….
Phone: ………………………………………………
E-Mail: ……………………………………………….

I give explicit consent to the processing, recording, storage and, when necessary, transfer of my personal data within the scope specified below:

1. Data Subject to Consent

Identity information, contact information, appointment and procedure information, my health data generated during the medical diagnosis and treatment process (blood test results, examination notes, imaging results, epicrisis, etc.), my payment and invoice information.

2. Purposes of Processing

• Planning and conducting diagnosis and treatment processes,

• Provision and development of health services,

• Conducting appointment and patient registration processes,

• Continuing communication activities,

• Fulfilling legal obligations,

• Conducting accounting and finance processes.

3. Transfer

When necessary, my personal data;

• To the Ministry of Health and its affiliated organizations,

• To private insurance companies,

• To laboratories and healthcare providers,

• To authorized institutions and organizations due to legal obligations

I allow it to be transferred.

4. Storage Period

My data will be stored for the period specified in the relevant legislation or for a limited period required by the purpose of processing.

5. My Rights

As the data owner, in accordance with Article 11 of the KVKK; I know that I have the right to request information about my personal data, to request correction or deletion, and to object to processing.

I accept and declare that I have given explicit consent to the processing of my personal data within the scope explained above.

Date: …../…../……
Signature: ______________________