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Çakırtepe Hastanesi
Corporate

PRIVATE ÜNYE ÇAKIRTEPE HOSPITAL
DATA SUBJECT APPLICATION FORM

GENERAL EXPLANATIONS

Personal data subjects ("Data Subject"), defined as the relevant person in the Personal Data Protection Law No. 6698 ("Law"), are granted certain rights regarding their personal data under Article 11 of the Law. It is regulated that they must apply to the Data Controller to exercise these rights.

Pursuant to paragraph 1 of Article 13 of the Law; applications regarding these rights to ÇAKIRTEPE SAĞLIK HİZ.TUR.LTD.ŞTİ ("Data Controller" or "Company") must be submitted using the methods below.

APPLICATION METHOD

You can submit your request regarding the exercise of your rights mentioned above in writing in Turkish, or by using a Registered Electronic Mail (KEP) address, secure electronic signature, mobile signature, or the electronic mail address previously registered in the Company's records, in accordance with paragraph 1 of Article 13 of the Law No. 6698 and the Communiqué on the Procedures and Principles of Application to the Data Controller.

The Company reserves the right to verify your identity before responding.

Your application must include:

  • Your name, surname, and signature if the application is written,
  • For citizens of the Republic of Turkey, your TR identity number; if you are a foreigner, your nationality, passport number, or identity number, if any,
  • Your residential or workplace address subject to notification,
  • Your e-mail address, telephone, and fax number subject to notification, if any,
  • The subject of your request.

Information and documents related to the subject must also be attached to the application.

Written Applications: You can submit your written applications by printing this page, filling it out, and delivering it to the Company's general directorate or authorized personnel with necessary documents attached.

E-mail Applications: You can make your applications via e-mail to kvkk@cakirtepehastanesi.com.tr. You can make your applications via KEP to cakirtepe.saglik@hs03.kep.tr.

If the requested information and documents are not provided properly, there may be disruptions in the complete and qualified execution of the research to be conducted by our Company regarding your request. In this case, our Company reserves its legal rights. To ensure the security of your personal data, our Company may contact you and request certain information within seven (7) days to confirm your identity. If documents are missing, the thirty (30) day legal response period will be suspended until they are completed.


1. APPLICANT INFORMATION

Name Surname:
ID / Passport Number:
Date of Birth:
Mobile Phone:
E-Mail (For faster response):
Address:

2. RELATIONSHIP WITH OUR INSTITUTION

Patient / Relative
Business Partner
Visitor
Former Employee
Job Applicant
Third-Party Firm Employee

3. YOUR REQUEST UNDER THE LAW

Please select the relevant request(s) below and provide necessary details:

No Subject of Request (Article 11 of the Law) Your Selection
1 I want to know if your Company processes personal data about me. [   ]
2 If your Company processes my personal data, I request information about these data processing activities. [   ]
3 If your Company processes my personal data, I want to learn the purpose of processing and whether they are used appropriately. [   ]
4 If my personal data is transferred to third parties at home or abroad, I want to know these third parties. [   ]
5 I think my personal data is incomplete or incorrectly processed, and I want them to be corrected. [   ]
6 Although my personal data has been processed in accordance with the law, I think the reasons requiring its processing have disappeared, and I request:
a) Deletion [   ]
b) Anonymization [   ]
[   ]
7 I want my incomplete/incorrect data (Request 5) to be corrected by the third parties to whom it was transferred. [   ]
8 I want my data (Request 6) to be deleted/anonymized by the third parties to whom it was transferred. [   ]
9 I think my processed personal data is analyzed exclusively through automated systems, resulting in an outcome against me. I object to this result. [   ]
10 I have suffered damage due to the unlawful processing of my personal data. I demand compensation for this damage. [   ]
I want it sent to my address.

I want it sent to my E-mail or KEP address.

I want to receive it by hand. (Requires notarized power of attorney if received by proxy)

In line with the requests I have specified above, I request that my application to your Company be evaluated and that I be informed pursuant to Article 13 of the Law.

Name Surname:
Date:
___/___/20___
Signature:
E-Appointment
E-Consultation
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