Information Text

EXPLICIT CONSENT TEXT FOR THE PROCESSING OF PATIENT AND PATIENT RELATIVE PERSONAL DATA

I have read the Information Text on the Processing of Patient and Patient Relative Personal Data, and within this scope:

I acknowledge, declare, and undertake that I give my prior consent to the collection, recording, processing, storage, retention, transfer, and preservation of my personal data by the data controller MEDİPRO PLUS HEALTH SERVICES, HEALTH TOURISM, AND HEALTH CONSULTANCY TRADE LIMITED COMPANY (hereinafter referred to as “International Medipro Plus Turkey” or the “Institution”) and its data processors (International Medipro Plus Turkey’s SGK-registered employees), and I accept that it may be shared as specified below.

Pursuant to Law No. 6698 on the Protection of Personal Data and the Regulation on the Processing and Protection of Privacy of Personal Health Data, I consent to the processing, preservation, and sharing of my personal data, special category personal data, and health data, including any identifying information I have provided verbally, in writing, and/or electronically, as defined in the aforementioned law and regulation. I hereby acknowledge, declare, and undertake that I consent to the processing and sharing of my personal and special category personal data as detailed below.

Scope of Personal Data Processing:

• Identifiable personal data processed automatically or manually within a data recording system, including name, surname, Turkish ID number, nationality, mother’s name, father’s name, place and date of birth, gender, tax number, social security number, signature, and official identification documents (e.g., driver’s license, passport, ID card);
• Contact details, including phone number, address, email address, fax number, and IP address;
• Personal data collected at physical locations, including security camera footage, fingerprint records, and other security measures;
• Photographs, video recordings (excluding security camera footage), and copies of documents containing personal data;
• Health data as defined in Article 6 of Law No. 6698, including but not limited to blood type, biometric data, and other medical records.

I am fully informed about how my personal data and that of my dependents will be processed by International Medipro Plus Turkey, including transfer to the Turkish Ministry of Health, affiliated institutions, and private information management systems. Additionally, I understand that my data may be processed for the purposes of appointment scheduling, medical treatment planning, financing, complaint tracking, archiving, and providing information to authorized persons and institutions.

I grant my consent to the collection, recording, processing, storage, and transfer of my personal and special category personal data by International Medipro Plus Turkey and its data processors (SGK-registered employees) under the legal framework.

I agree / I do not agree.

I grant my consent for my personal data to be transferred in a limited manner to domestic and international suppliers (e.g., sworn financial advisors, legal consultants, IT service providers, catering, and hospital service providers) related to the services provided to the Institution.

I agree / I do not agree.

I grant my consent for my identity, medical, and visual data to be transferred to domestic and international healthcare institutions for diagnosis and treatment purposes.

I agree / I do not agree.

I understand that the transfer of my medical data to my private insurance company or intermediary agencies authorized by my private insurance company is necessary for medical service reimbursement and coverage. I consent to the transfer of my health data by International Medipro Plus Turkey and its data processors (SGK-registered employees) to my private insurance company, supplementary health insurance company, or authorized intermediary institutions.

I agree / I do not agree.

I consent to the processing, storage, and use of medical photographs taken during my medical procedure/treatment, and their use in advertising materials, the website, brochures, and announcements by International Medipro Plus Turkey.

I agree / I do not agree.

I consent to receiving appointment reminders and promotional information via electronic mail, social media, or SMS.

I agree / I do not agree.

I consent to the transfer of my medical data to healthcare institutions, doctors, and healthcare personnel abroad for the purpose of consultation, testing, or medical examination.

I agree / I do not agree.

Explicit Consent for the Transfer of Special Category Personal Data to Family Members and Other Authorized Persons

Pursuant to Law No. 6698, the Regulation on Patients’ Rights, and the Regulation on the Processing and Protection of Privacy of Personal Health Data, my health data (e.g., test results, examination details, appointment information, and general medical condition) may be transferred to the following individuals I have designated, excluding cases requiring mandatory disclosure by court order or legal obligation (e.g., Turkish Ministry of Health, Social Security Institution, courts, hospitals, and hospital information management systems):

Full Name:
Relationship Degree:
Turkish ID No.:
Contact Information:

(The patient should manually fill in the details of the family member, companion, or third party to whom data transfer is permitted.)

I agree / I do not agree.

I declare that I have informed the individuals listed above about the transfer of their special category personal data to International Medipro Plus Turkey and that I have obtained their consent where necessary.

Patient / Patient’s Legal Representative / Guardian / Parent (for minors)

Full Name:
Relationship Degree (to the patient):

Date:
Signature:

Interpreter/Witness (if required):
Full Name:

Date:
Signature: