EXPRESS CONSENT FORM FOR THE PROCESSING OF PERSONAL DATAOp Dr. Your personal data, which is detailed in the Information/Information text on the Processing of Personal Data by Duygu AKSOY Practice, is mandatory for the performance of the contract, if it is clearly foreseen by law, for us to fulfill our legal obligations, and for the protection of public health, preventive medicine, medical diagnosis, treatment and care services, Except for processing and transferring to the extent necessary for the purpose of planning and management of health services and financing; We request your explicit consent regarding the following matters;Collection, Processing and Processing Purposes of Personal DataIn order to provide us with high standards of service, I have been informed by reading the General Disclosure text on the Protection and Processing of Personal Data that you have obtained my personal data verbally, in writing, visually or electronically from our switchboard, internet, mobile applications, physical locations 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 that is necessary 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 if I am a Turkish citizen, place and date of birth, gender information, and a photocopy of the TR ID Card or Driver’s License that I have submitted,
• My contact data such as my address, telephone number, e-mail address,
• My financial data such as my bank account number, IBAN number,
• My health and sexual life-related data obtained during the execution of medical diagnosis, treatment and care services, such as my laboratory and imaging results, test results, examination data, prescription information, which I provide for tracking purposes in my file,
• The answers and comments I shared to evaluate your services,
• My closed circuit camera system image and audio recording taken during my visit to your practice,
• My data regarding private health insurance and Social Security Institution data for the purpose of financing and planning health services,
• My navigation information, IP address, browser information and medical documents, surveys, form information and location data that I submit with my own consent, obtained during the use of your website and mobile application.

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

• Protection of public health, 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,
• Fulfilling legal and regulatory requirements,
• Financing my health services, covering your examination, diagnosis and treatment expenses by the Patient Services, Financial Affairs and Marketing departments, sharing the requested information with private insurance companies within the scope of eligibility inquiry,
• To be informed about my appointment through your switchboard,
• Conducting analysis for the purpose of improving healthcare services by the Quality, Patient Experience and Information Systems departments,
• Providing training to your employees by our relevant units,
• Invoicing for your services by Patient Services, Financial Affairs and Marketing departments,
• Confirming my relationship with the institutions contracted with our practice, Answering all my questions and complaints regarding the health services provided/to be provided to me by our practice,
• Our practice takes all necessary technical and administrative measures within the scope of data security of your hospital’s systems and applications,
• Participating in campaigns and providing campaign information by our practice, designing and delivering special contents and concrete and intangible benefits on web and mobile channels,
• Measuring, increasing and researching patient satisfaction by our practice,
• In order to carry out education and training activities by the educational institutions with which our practice cooperates.

I have been informed in detail that my “Personal and Special Data” mentioned above can be kept in physical and electronic archives within our practice or external service providers with great care and compliance with the legislative provisions.Transfer of Personal DataMy personal data is subject to the Health Services Basic Law No. 3359, Decree Law No. 663 on the Organization and Duties of the Ministry of Health and its Subsidiaries, Personal Data Protection Law No. 6698, Private Hospitals Regulation, Regulation on the Processing of Personal Health Data and Protection of Privacy and Ministry of Health regulations and other. Within the framework of the legislative provisions and for the purposes explained above;

• Ministry of Health, with sub-units and family medicine centers affiliated to the ministry,
• Private insurance companies (health, pension, life insurance and similar),
• With the Social Security Institution,
• With the General Directorate of Security and other law enforcement agencies,
• With the General Directorate of Population,
• With the Turkish Pharmacists Association,
• With judicial authorities,
• With laboratories, medical centers, ambulances, medical devices and institutions providing health services in the country or abroad with which you, as our Practice, cooperate for medical diagnosis and treatment,
• In case I am referred, with another health institution to which I am referred or to which I apply myself,
• With the legal representatives I have authorized,
• With third parties from whom you receive consultancy, including the lawyers, tax advisors and auditors you work with,
• With regulatory and supervisory institutions and official authorities,
• If my invoicing will be made to the employer, contact my employer for this purpose,
• It can be shared with the suppliers, support service providers, archive service providers and business partners whose services you benefit from or cooperate with as a practice.

Method and Legal Reason for Collecting Personal DataMy personal data is collected and processed in all kinds of verbal, written, visual or electronic media, for the purposes stated above and for the execution of all kinds of work within the scope of our Practice’s field of activity within the legal framework, and in this context, for our Practice to fully and properly fulfill its contractual and legal obligations. I was informed. These persons are the legal reason for collecting my data;

• Personal Data Protection Law No. 6698,
• Health Services Basic Law No. 3359,
• Decree Law No. 663 on the Organization and Duties of the Ministry of Health and its Subsidiaries,
• Private Hospitals Regulation,
• Regulation on the Processing of Personal Health Data and Protection of Privacy,
• Ministry of Health regulations and other legislative provisions.

In addition, as stated in the 3rd paragraph of Article 6 of the Law, personal data regarding health and sexual life are kept confidential only for the purpose of protecting public health, carrying out preventive medicine, medical diagnosis, treatment and care services, planning and management of health services and their financing. I know that it may be processed by persons under liability or authorized institutions and organizations without my explicit consent. Your Rights Regarding the Protection of Personal DataIn accordance with the law and relevant legislation;

• Learning whether my personal data is being processed or not,
• Requesting information if my personal data has been processed,
• Accessing and requesting my personal health data,
• Learning the purpose of processing my personal data and whether they are used for their intended purpose,
• Knowing the third parties to whom my personal data is transferred at home or abroad,
• Requesting correction of my personal data if they are incomplete or incorrectly processed,
• Requesting the deletion or destruction of my personal data,
• In case my personal data has been processed incompletely or incorrectly, to request the correction of these and/or the deletion or destruction of my personal data to be notified to third parties to whom my personal data has been transferred,
• Object to the emergence of a result unfavorable to me by analyzing my processed data exclusively through automatic systems,
• I was informed that I have the right to request compensation for the damage if I incur any damage due to the unlawful processing of my personal data.

By filling out the “Application Form in accordance with the Personal Data Protection Law”;

• Metin Kasapoğlu Cad. Yeşilbahçe Mah. Zafer Apt. I can personally deliver it to the address No:25 Floor:1/3 Muratpaşa/ANTALYA,
• I can send it through a notary,
• I know that I can send it to aksoy@hs01.kep.tr with a secure electronic or mobile signature, via my registered e-mail address or my e-mail address registered in your system.

Op Dr. I have read and understood the General Information on Protection and Processing of Personal Data prepared by Duygu AKSOY Practice,Protection and Processing of Personal Data I have been informed about the purposes of processing my personal data, which are detailed in the General Information text, the institution, organization, company and health professionals to which it is transferred, methods of collection and legal reasons, my rights to protect my personal data, data security and my right to apply,My personal and special data; Personal Data is processed and transferred to the extent necessary for the performance of the contract, if it is clearly foreseen by law, if it is mandatory for our Practice to fulfill its legal obligations, and for the purposes of protecting public health, preventive medicine, medical diagnosis, treatment and care services, planning and management of health services and their financing. Preservation and Processing Preservation, processing and transfer in accordance with the matters specified in the General Information text.I ACCEPT WITH EXPRESS CONSENT.In accordance with the Patient Rights Regulation; 1 copy of the form will be given to you. If the form is not given to you, please report it.CONSENTWrite “I understood what I read” in your own handwriting:……………………………………………………………… Patient Name and Surname………………………………………………Signature:………Date: ……./……./………Time:….. Patient Relative Name and Surname:………………………………..…Signature:…………Date: ……./……./………Time:….. The degree of proximity: …………………………………………… Reason for Obtaining Consent from the Patient’s Relative:

• The patient is less than 19 years old (Signature is taken from both parents – mother and father. However, if the family is divorced, the signature is taken from the parent who has custody)
• Does not have the power to appeal / has no decision-making ability (Signature is obtained from the guardian or legal representative)
• Unconscious

INTERPRETER (If the patient has a language / communication problem)In my opinion, the information I translated was understood by the patient/patient’s relative. Translated by; Name Surname:……………………………………… Signature: …………………..…Date: …../……./……… Time:……