DOCUMENT 1: CLARIFICATION TEXT
(To be presented to the patient)
CLARIFICATION TEXT ON THE PROCESSING AND PROTECTION OF PERSONAL DATA
These data are processed based on the legal grounds specified in Articles 5 and 6 of the Law: “Explicitly stipulated in laws”, “Execution of medical diagnosis and treatment services”, “Legal obligation of the data controller”, “Performance of the contract”, “Legitimate interest”, and “Explicit consent of the data subject”.
You can submit your requests to the address: info@celalettinperu.com.
DOCUMENT 2: EXPLICIT CONSENT AND APPROVAL FORM
(This document must be obtained from the patient with a wet signature)
KVKK (LPPD) EXPLICIT CONSENT STATEMENT
I have read and understood the “Clarification Text” presented by the Data Controller Specialist Dr. Celalettin PERU (“Company”). I have been informed in detail regarding the processing of my personal data, my rights, and to whom and for what purposes my data will be transferred.
I hereby declare my preferences on the following issues with my free will: (Please check the relevant boxes)
DECLARATION AND ACCEPTANCE Furthermore, I accept and declare that the personal data I have shared with the Company is accurate and up-to-date, and that I will notify the Company in case of any changes in this information.
I accept and declare that I have explicit consent for the processing, use limited to the processing purpose within the relevant process, sharing, and storage for the required period of my relevant personal data, including my special categories of personal data defined in the Law on Protection of Personal Data, and that necessary clarification has been made to me in this regard; and that I have read this text and the Clarification Text.
Patient / Concerned Person Name Surname: ________________________________________ ID / Passport No: __________________________________________ Date: _____ / _____ / 20_____ Signature: _________________________
