RODO

PERSONAL DATA PROCESSING – INFORMATION FOR PATIENTS

Based on the Personal Data Protection Act of 29 August 1997 and the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) we hereby inform you* that the Controller of the personal data provided by you is Estetyka dr n. med. Lidia Majewska with its registered office in Kraków 30-548, ul. Lwowska 1 lok. 16, biuro@esmeclinic.pl. Pursuant to Article 13(1) and (2) of the General Data Protection Regulation of 27 April 2016, we also inform you that:

• The contact details of the Data Protection Inspector are available from the Controller;
• Your personal data will be processed for the purposes of providing healthcare services, maintaining medical records, storing them and making them available, as well as settling payments for the provided healthcare services. The data is also used for marketing purposes and to manage the bookings of appointment, consultation and medical procedure dates based on Article 6(1)(a) and (b) of GDPR;
• You have the right to access your data and the right to its rectification, erasure, restriction of processing, the right to object to its processing, the right to data portability, the right to withdraw the consent at any time, without affecting the lawfulness of processing based on consent before its withdrawal;
• The data will be processed until the purpose for which it was collected is no longer valid or until the data subject objects to the processing of the personal data, whichever is sooner. In case of reasonable doubts, you are entitled to lodge a complaint (after 25 May 2018) to the President of the Personal Data Protection Office.
• Providing your personal data is a necessary precondition for concluding the agreement and providing medical services at the aforementioned facility.

The data controller is bound by the personal data protection provisions of the Regulation of the Minister of Health of 21 December 2010 on the type and scope of medical records and the method of processing them**, as well as of the Act of 6 November 2008 on Patients’ Rights and the Commissioner for Patients’ Rights***. Pursuant to the provisions of the Act, the data required to maintain medical records, referred to in Article 25, must not be deleted.

*     Consolidated text: Journal of Laws of 2002, no. 101, item 926, as amended
**   Consolidated text: Journal of Laws of 2004, no. 100, item 1024
*** Consolidated text: Journal of Laws of 2012, item 159, as amended

PATIENT’S DECLARATION OF CONSENT TO PERSONAL DATA PROCESSING

I, the undersigned ………………….……………………………………………………………………………………..

in accordance with Article 7(2) of the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 (GDPR*) hereby voluntarily consent to the processing and collection of my personal data by Estetyka dr n. med. Lidia Majewska with its registered office in Kraków, ul. Lwowska 1 lok. 16. Consequently:

• I consent to the processing of my personal data, including sensitive data, i.e. health-related data, for purposes related to the provision of medical and cosmetology services, settling the relevant payments, as well as maintaining medical records, storing them and making them available by Estetyka dr n. med. Lidia Majewska with its registered office in Kraków, ul. Lwowska 1 lok. 16.
• I consent to the processing of my personal data, including my contact details, for purposes related to confirming and cancelling appointments at the facility by phone and SMS by Estetyka dr n. med. Lidia Majewska with its registered office in Kraków, ul. Lwowska 1 lok. 16.
• I hereby consent / do not consent** to the processing of my personal data for marketing purposes related solely to the operations of Estetyka dr n. med. Lidia Majewska with its registered office in Kraków, ul. Lwowska 1 lok. 16.

I further represent that my consent meets all the requirements specified in Article 7 of GDPR, i.e. I am entitled to withdraw it at any time, and the request for consent has been presented to me in a comprehensible manner.

Place, date and signature of the Patient ……………………………………………………………………………………………………….

 * Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation)

** delete as appropriate