Contact information of the applying data owner: Name, Surname: T.R. Identification number: Phone Number: Email Address: House Phone: Address: Contact information of the authorized person who made the application on behalf of the data owner: Name, Surname: T.R. Identification number: Phone Number: Email Address: House Phone: Address: Demands and requests: Your Current Location: Patient The relatives of the patient Worker Former Employee Other Your requests: Is my personal data processed by your institution? What are the processing activities of my personal data? What is the purpose of processing personal data? Are personal data transferred to third parties at home or abroad? I have a request for correction of personal data as stated below. I have a request for deletion of the personal data I have mentioned below. I have an anonymization request regarding my personal data that I have stated below. I request that my correction and/or deletion request be notified to the following persons. I request that my personal information not be shared with anyone except for legal obligations. I allow my clinical photos to be taken and used for diagnostic, scientific, educational or research purposes together with clinical data by keeping my identity information confidential for educational, diagnostic, follow-up and scientific purposes. I request that my personal information be shared with the Ministry of Health. I request compensation for the damage I have suffered due to the unlawful processing of my personal data. (Please indicate the reason for this request and the damage you think you have suffered in the space below; please include the supporting information and documents regarding these issues (for example, the Personal Data Protection Board or court decisions) in the Appendix to the Application Form.) Descriptions: I want it to be sent to the address I specified above. I want it to be sent to my e-mail address that I specified above. I want to receive it by hand. (In case of receipt by proxy, a notarized power of attorney or authorization document is required.) KVKK Metni'ni Okudum, Anladım, Onaylıyorum. Send
