Explict Consent Form For Health Check Form

You have filled out the Health Check Form on our website so that we, as Clinic Mono, can serve you correctly and plan future procedures. By accepting this Explicit Consent Text, you hereby acknowledge that you are aware of the following matters and that you give your consent with your free will.

By signing this form;

I hereby consent to sharing personal data with LAL YAPI TUR. SEY. ORG. SAN. VE TİC. A.Ş.(hereinafter referred to as ” LAL YAPI TUR. SEY. ORG. SAN. VE TİC. A.Ş. “) in accordance with the purposes listed below and to the processing and transfer of this information with this Form in accordance with the Personal Data Protection Law No. 6698.

Data that I consent to processing and transferring;

1. ID datas such as name, surname, birthplace and date, country
2. Contact and location data such as address, location information, phone number, e-mail address,

• Your health data such as BMI index, height, weight, date of last menstrual period, prescription or non-prescription drugs used, number of pregnancies, number of live births, date of last birth, contraceptive method, date of menopausal onset, drug allergies and reactions to drugs, reactions to anesthesia, blood transfusions, sexually transmitted diseases, hepatitis, HIV, breastfeeding, hereditary health problems, diabetes, insulin use, oral antidiabetic pills if used, blood pressure, presence of cancer, kidney disease, epilepsy and seizures, anemia, arthritis, asthma/emphysema, dysphagia/stroke, abnormal vaginal bleeding, swollen glands, anxiety, reflux, chest pain, shortness of breath, sleep difficulties/apnea, nausea, dizziness, murmur, cardiac insufficiency, rhythm disorders, surgical history and surgery dates if any, and other health data,

1. Other data such as Marital status, occupation, smoking, alcohol and other drug use, drug use

Your collected personal data are stipulated by Law No. 6698 and GDPR, a) Compliance with the law and the rules of honesty, b) Being accurate and up-to-date when necessary c) Being processed for specific, clear and legitimate purposes, d) Being linked, limited and proportionate to the purpose for which they are processed, e) In accordance with the basic principles of preservation for the period required by the relevant legislation or for the purpose for which they are processed; Law No. 6698;

Article 5/1 within this framework “Obtaining the explicit consent” of the Data Subject

Article 5/2 (a) “It is expressly permitted by any law”

Article 5/2 (b) “It is necessary to protect the life or physical integrity of the data subject or another person, and the data subject is unable to provide consent due to actual impossibility or lacks legal capacity to give valid consent”

Article 5/2 (c) “It is necessary to process the personal data of parties of a contract, provided that the processing is directly related to the execution or performance of the contract”

Article 5/2 (ç) “It is necessary for compliance with a legal obligation which the controller is subject to”

Article 5/2 (e) “Data processing is mandatory for the establishment, exercise or protection of a right”

Article 5/2 (f) “It is necessary for the legitimate interests of the data controller, provided that the fundamental rights and freedoms of the data subject are not harmed” it will be processed for the following purposes:

Similarly, your collected personal data are stipulated by Law No. 6698 and GDPR within the framework of:

Article 6/2 (a) “Obtaining the explicit consent” of the Data Subject,

Article 6/2 (b) “It is expressly permitted by any law,”

Article 6/2 (c) “It is necessary to protect the life or physical integrity of the person who is unable to express consent due to actual impossibility or whose consent is not legally valid,”

Article 6/2 (d) “It is necessary for the establishment, exercise, or protection of a right,”

Article 6/2 (e) “It is necessary for the purposes of public health protection, preventive medicine, medical diagnosis, treatment, and care services, or the planning, management, and financing of health services, by persons or authorized institutions and organizations obligated to maintain confidentiality,”

and it will be processed for the following purposes:

I give my explicit consent and permission to the processing of my personal data for the following purposes and to its transfer to third parties inside and outside the company;

especially;

1. Protection of public health, preventive medicine, medical diagnosis, aesthetic, treatment and care services,

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

iii.Fulfillment of legal and regulatory requirements,

1. Financing health services, covering your examination, diagnosis and treatment expenses, sharing the requested information with private insurance companies within the scope of the eligibility inquiry,
2. To be informed about our clinic and our services through your Call Center and Digital Channels,

vi.Confirmation of identity by Patient Services, your Health Professionals and Call Center departments,

vii.Planning and managing the internal functioning of the practice, clinic and hospital,

viii.To be able to respond to all your questions and complaints regarding the health services provided/to be provided by the Call Center departments,

1. Taking all necessary technical and administrative measures within the scope of data security of the systems and applications of your clinic by the Information Systems departments,
2. Providing campaign participation and campaign information by Call Center departments, designing and communicating special content, tangible and intangible benefits on web and mobile channels,

• Transfer of Your Personal Data

Your personal data can be transferred to public institutions (such as ministries and Presidency boards) within the scope of the purpose and limitations stipulated by the law, if requested in cases clearly stated in the laws.

Your personal data, within the framework of the Fundamental Law on Health Services No. 3359, the Decree-Law No. 663 on the Organization and Duties of the Ministry of Health and its Affiliates, the Personal Data Protection Law No. 6698, the Regulation on Private Hospitals, the Regulation on the Processing and Protection of Privacy of Personal Health Data, the Regulation on the Procedures and Principles for the Transfer of Personal Data Abroad, the regulations of the Ministry of Health, and other relevant legislative provisions, and based on the following conditions: obtaining your explicit consent or compliance with the laws and regulations mentioned above in cases where data processing can be performed without explicit consent under the law, and for the purposes outlined herein, will be processed as follows:

Your personal data can be transferred to;

1. In order to fulfill the legal obligation, authorized official institutions and organizations and persons authorized by law,
2. Relevant judicial authorities and authorized attorneys for the execution or follow-up of judicial processes;
3. Professional consultants, accountants, and auditors employed by the data controller, for purposes such as business process development, conducting promotional and marketing activities, risk management, and fulfilling contractual obligations;
4. Private and official institutions, physicians with which the data controller has commercial, administrative, or contractual relations, for the fulfillment of contractual obligations, the establishment of rights, compliance with legal obligations, and within the scope of legitimate interests;
5. Domestic or international laboratories, medical centers, ambulance services, medical device providers, and healthcare institutions with which the data controller collaborates for medical diagnosis and treatment;
6. Another healthcare institution to which you are referred or have applied in the event of a referral;
7. Legal representatives you have authorized;
8. Consultants and service providers, including attorneys, tax advisors, accountants, and auditors with whom we work;
9. Regulatory and supervisory bodies and official authorities;

• Methods of Obtaining Personal Data

Although the methods of collecting personal data may vary depending on the service provided by LAL YAPI TUR. SEY. ORG. SAN. VE TİC. A.Ş. and the commercial activities of LAL YAPI TUR. SEY. ORG. SAN. VE TİC. A.Ş., your personal data will be collected through the form you have filled out.

The legal basis for the collection of this personal data is as follows:

1. The Personal Data Protection Law No. 6698,
2. The Fundamental Law on Health Services No. 3359,

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

1. The Regulation on Private Hospitals,
2. The Regulation on the Processing and Protection of Privacy of Personal Health Data,
3. The Turkish Code of Obligations,

• The Tax Procedure Law and other tax laws,
• Obtaining explicit consent,

1. The regulations of the Ministry of Health and other relevant legislative provisions.

Additionally, as stipulated in Article 6, Paragraph 3 of the Law No. 6698, personal data related to health and sexual life may be processed without your explicit consent in cases where:

1. It is explicitly permitted by law,
2. It is necessary to protect the life or physical integrity of a person who cannot express consent due to actual impossibility or whose consent is not legally valid,

• The personal data in question have been made public by the data subject, provided that the processing aligns with the purpose of publicization,

1. It is necessary for the establishment, exercise, or protection of a right,
2. It is necessary for public health protection, preventive medicine, medical diagnosis, treatment, care services, or the planning, management, and financing of health services, by persons or authorized institutions and organizations obligated to maintain confidentiality,

Under these conditions, your personal data may be processed by persons or authorized institutions and organizations obligated to maintain confidentiality, without requiring your explicit consent.

• Your Rights as a Data Subject listed in Article 11 of Law No. 6698 and GDPR

The rights of real persons, whose personal data are processed in accordance with Article 11 of Law No. 6698 are as follows;

1. Learning whether personal data is processed,
2. If personal data has been processed, to request information regarding this,

• Learning the purpose of processing personal data and whether they are used appropriately for their purpose,

1. To learn whether personal data are transferred domestically or abroad, and to know the third parties to whom it is transferred,
2. To request correction of personal data in case of incomplete or incorrect processing and to request notification to be made about the correction to third parties to whom personal data have been transferred,
3. Although it has been processed in accordance with the provisions of Law No. 6698 and other relevant laws, to request the deletion or destruction of personal data in the event that the reasons requiring its processing disappear, and to request notification to be made within this scope to third parties to whom personal data have been transferred,

• Object to the occurrence of a result that is disadvantageous of analyzing the processed data exclusively through automated systems,
• To request the compensation of the damage due to unlawful processing of personal data

6698. You can also withdraw your explicit consent given within the scope of this text. However, if there are other reasons for compliance with the Law No. 6698, your personal data processed for these reasons will continue to be processed in accordance with the principles stipulated in the law. Therefore, if you withdraw your explicit consent, the processing of your data processed solely based on your explicit consent will be terminated immediately, but your personal data processed in line with both your explicit consent and other legal compliance reasons stipulated in law numbered 6698 will continue to be processed within the framework of legal provisions. If you withdraw your explicit consent, a detailed information text will be sent to you in accordance with the principles in the law numbered 6698.

You can transmit your application for your rights listed above, with your request which contains the necessary information identifying your identity and your explanations about your right to use the rights specified in Article

11 of Law No.6698 with following methods: You can fill in the Data Subject Application Form at www.clinicmono.com and send a signed copy of the form to Adalet Mah. Manas Bulv. Folkart Towers A Kule K:20 D:2009, Bayraklı/Izmir, by hand with documents identifying you, you can send it via notary or other methods specified in the Law No. 6698. Or you can send the relevant form with secure electronic signature to [email protected]

Depending on the nature of the request, the request will be concluded free of charge as soon as possible, within thirty (30) days at the latest. However, if the transaction requires an additional cost, we will charge the fee in the tariff determined by the Board of Protection of Personal Data.

Applications can be made in English or Turkish. In the application there must be name, surname and signature if the application is written, Turkey Republic ID number for Turkey citizens, on the other hand, nationality, passport number / identity number, place of residence or workplace address for notification, e-mail address, telephone or fax number and subject of request for foreigners.

In the application containing the explanations about the right that the relevant person has and that he / she will make in order to exercise the above-mentioned rights and that he / she has requested to use; the requested matter should be clear and understandable, the requested subject must be related to the person. If he / she is acting on behalf of someone else, he / she must be specially authorized in this regard and must document his / her authority, identification and address information and documents proving identity must be attached to the application.

I have read and understood the Information/Clarification Text on the Processing of Personal Data prepared by the DATA CONTROLLER.

I acknowledge that I have been informed about the purposes for which my personal data will be processed, the institutions, organizations, companies, and healthcare professionals to whom they may be transferred, the methods of data collection and the legal basis for processing, my rights regarding the protection of my personal data, data security, and my right to apply, all as detailed in the Information/Clarification Text on the Processing of Personal Data.

I consent to the processing and transfer of my personal and special category data to the extent necessary for the following purposes: performance of a contract, Explicitly permitted by law, Fulfilling the legal obligations of the DATA CONTROLLER, Protection of public health, Protection of the life or physical integrity of a person who is unable to express consent due to actual impossibility or whose consent is not legally valid, either for their own benefit or for the benefit of another, Necessity for the establishment, exercise, or protection of a legal right, Processing required for the legitimate interests of the data controller, provided that it does not harm the fundamental rights and freedoms of the data subject, Conducting preventive medicine, medical diagnosis, treatment, and care services, as well as planning and managing healthcare services and their financing.

Furthermore, I agree that my personal data will be retained, processed, and transferred in accordance with the conditions outlined in the Information/Clarification Text on the Processing of Personal Data, except in cases where the above purposes require otherwise.

We declare in the capacity of “Data Controller” within the scope of Law No. 6698 and GDPR.

Regards,

LAL YAPI TUR. SEY. ORG. SAN. VE TİC. A.Ş.

Adress: Adalet Mah. Manas Bulv. Folkart Towers A Kule K:20 D:2009, Bayraklı/Izmir

Phone: +90 549 675 10 17

E-Mail: [email protected]