DATA PROCESSING CONSENT FORM
1. I hereby freely and voluntarily give my consent to TimesMed Philippines, Inc. (the “Corporation”) the right to process, as defined under the Data Privacy Act of 2012 and its implementing rules and regulations, my personal information and sensitive personal information (the “Personal Data”), including among others my complete name, e-mail address, contact number, gender, physical address, clinic address, city, zip code, state, birthday, appointment details, appointment dates, appointment time, appointment locations and Doctors;
2. I hereby manifest that I understood, acknowledged and informed that the Personal Data collected from me will be processed for the following purposes, to wit:
a. Marketing and research;
b. Information dissemination;
c. Insurance Claims;
d. Security and safety; and
e. Identity verification.
3. Further, I hereby also give my permission to the Corporation to disclose my Personal Data to related/affiliate entities, contracting parties, partners, third-party service providers and other organizations, for purpose related to those above enumerated. These may include:
a. Medical providers, employee assistance providers, insurers, investigators and regulators and similar entities for Health and safety purposes;
b. Third parties who provide services to the Corporation, so that such organizations and contractors can assist the Corporation with the purposes for which it processes your information, including marketing service providers, online service providers, data processing, data analysis, document management, research, investigations, insurance, surveillance, and information-vetting;
c. Public service departments and other bodies where the Corporation is required by law;
d. A Customer’s authorized representatives; and
e. Law enforcement and national security agencies, and other public authorities, as required or authorized by law.
4. I hereby authorized the Corporation to retain and store the Personal Data collected from me for as long as necessary to accomplish the above mentioned purposes and that such data may be recorded, organized, stored, used, consolidated, updated, modified, blocked, erased, deleted, shared, analysed, and operated upon in any manner whatsoever by the Corporation or other entities enumerated in Number 3 hereof, in furtherance of the abovementioned purposes;
5. I am informed of my right under the Data Privacy Act of 2012, which include the right to access, information and correction, and the right to object as can be gleaned in http://www.officialgazette.gov.ph/2012/08/15/republic-act-no-10173. and I have read and understood the Corporation’s Terms and Conditions Manual at link. (Creating a link)
6. By clicking the “I Agree” button below, I hereby certify that:
[a] I have read this Data Processing Consent Form,
[b]I have read the Corporation’s Terms and Conditions Manual,
[c]I give my free, full, and intelligent consent to the abovementioned activities, and those described in the Customer Privacy Manual, and
[d]the Corporation has completely and sufficiently complied with the Data Privacy Act of 2012, its implementing Rules and Regulations, and the other issuances of the National Privacy Commission.
