Consent to Provide Information about State of Health

As part of the provision of health services, we process data on the client's state of health, as well as related personal data, and, to the extent necessary, the personal data of other persons provided by the client. All processing of personal data is in accordance with applicable law, especially European Parliament and Council (EU) Regulation No. 2016/679 on the Protection of Natural Persons with Regard to the Processing of Personal Data and on the Free Movement of Such Data and on Repealing Directive 95/46/EC, the so-called GDPR. Detailed information on the processing of patients' personal data is published on the health service provider's website: https://www.gennet.cz/en/information-about-the-processing-of-personal-data-of-patients-by-healthcare-facilities.

Please note that in case of undergoing assisted reproductive treatment it is necessary that the treated couple gave each other consent to communicate information on the state of health, as the treatment of both partners is linked and the information on the state of health of one of the partners may not be separated from the information on the state of health of the other partner.

1. INFORMING OTHER PERSONS ABOUT MY STATE OF HEALTH

I agree that all personal data and any data about my state of health that I pass on to GENNET, s.r.o. for the purpose of assisted reproduction treatment planning may be shared with my partner, stated by me in the Patient Form, which will be sent to me later. At the same time, I declare that I have informed my partner of this fact and he has given his consent.

I understand that persons close to me (e.g. my mother) as defined in the provisions of Section 22 of Act No. 89/2012 Coll., the Civil Code, do not need my consent to provide information about my state of health unless I expressly ban such persons in writing.

I agree that the person or persons acquiring the competence to pursue the profession of healthcare and other professionals as well as healthcare professionals, under the direct guidance of whom the teaching and practice of the persons concerned is conducted, shall have the right to consult my medical records to the extent necessary for securing the teaching

2. COMMUNICATION OF INFORMATION VIA TELEPHONE OR E-MAIL

I acknowledge that neither telephone nor e-mail communication may guarantee sufficient protection of personal data because it is not possible to verify to whom the personal data have been transmitted and that the health service provider bears no responsibility for these consequences and, to the extent of the information communicated via e-mail or telephone, is relieved of the confidentiality obligation.

I hereby expressly request that all information required about my state of health is communicated to me only via the e-mail that I have provided in the contact form, or that all information required about my state of health be communicated to me only via telephone, only through the phone number I provided in the contact form.

In the event of a change in the e-mail address or telephone number, I agree to inform the health care provider (GENNET, s.r.o.) immediately of this change. If I fail to do so, communication in this way will no longer be possible.

I acknowledge that the health service provider has no responsibility for these consequences and, to the extent of the information communicated via e-mail or telephone, is relieved of the confidentiality obligation.