CONSENT AND ACKNOWLEDGMENTS IN TERMS OF THE PROTECTION OF PERSONAL INFORMATION ACT NO 4 OF 2013 (POPI)
The Protection of Personal Information (POPI) Act aims to give effect to the constitutional right to privacy by balancing the right to privacy against that of access to information. The POPI Act requires that personal information pertaining to individuals be processed lawfully and in a reasonable manner that does not infringe on the right to privacy.
This consent form sets out how personal information will be processed by Dr Andre de Villiers. The use of the words “the party” for the purposes of this document shall be a reference to any party dealing or communicating with Dr Andre de Villiers and/or concluding any agreement, whether of employment, of service provider, client or patient, or in any other legal capacity, with the inclusion of each party referred to or included in terms of such exchange or agreement.
Should you be an employee of Dr De Villiers, he may process personal information about you in your capacity as data subject related to names and surnames, identity numbers, gender, marital status, health, disability, well-being or medical history, email addresses, physical addresses, telephone numbers, language, employment history and account numbers. The purpose of processing such personal information about you is to communicate directly with you, to give effect to the contract of employment with you, to protect your legitimate interests through such performance and to comply with relevant statutory provisions.
Should you be a client purchasing products and/or services from Dr De Villiers, a patient receiving medical treatment from Dr De Villiers, or a parent or a guardian of a minor receiving medical treatment from Dr De Villiers, he may process personal information about you in your capacity as data subject related to names and surnames, identity numbers, gender, health, disability, well-being or medical history, email addresses, physical addresses, telephone numbers, language and account numbers. The purpose of processing such personal information about you is to communicate directly with you, to perform upon the specific agreement with you or the minor represented by you, whether for medical treatment or related products or services, to protect your legitimate interests or those of the minor you represent through such performance and to comply with relevant statutory provisions.
Should you be the parent or guardian of a minor, in processing personal information about children whether any or all of the above categories, Dr De Villiers will strictly comply with the legislative guidelines as set out in Section 35 of the POPI Act involving the general authorisation concerning
personal information of children.
Dr De Villiers will only collect personal information for the purposes as stated above. As part of the processing of personal information about you, of your child, or that of the minor under your guardianship, Dr De Villiers will collect such information from you, through your status as employee, client, patient, guardian or representative of a minor, or otherwise. He may also collect such information from medical practices and professionals, private medical institutions, from relevant public or equivalent entities, or from his own records related to previous services or products provided to you. As part of the processing of personal information about you, Dr De Villiers may also disclose such personal information to medical practices and rofessionals, private medical institutions, statutory institutions such as SARS, relevant public or equivalent entities on whose behalf he may act as intermediary, or other third parties agreed to in writing with you the data subject.
Consent and permission to process personal information
Through reading this statement you are explicitly requested to resolve whether you consent to Dr De Villiers processing your personal information or that of your child or the minor under your guardianship by responding to the consent request addressed at you. Should you not consent to Dr De Villiers processing your personal information, or that of your child or the minor under your guardianship, the consent request allows for the data subject to opt out. Should you not respond, your consent for Dr De Villiers to process your personal information or that of your child or the minor under your guardianship is implied. Should you choose to opt out from Dr De Villiers processing your personal information or that of your child or the minor under your guardianship, you understand that withholding consent or failure to disclose personal information will result in Dr De Villiers being unable to perform his functions and/or any services or benefits you or your child or the minor under your guardianship may require from him. You also indemnify and hold Dr De Villiers harmless in respect of any claims against him by any other person on whose behalf you have consented should they claim that you were not so authorized. You furthermore understand that in terms of the POPI Act and other laws of the country, there are instances where your express consent is not necessary in order to permit the processing of personal information, which may be necessary for the establishment, exercise or defence of a right or obligation in law, or related to police investigations, litigation or when personal information is publicly available. You will not hold Dr De Villiers responsible for any improper or unauthorized use of personal information that is beyond his reasonable control.
Your rights regarding the processing of personal information
You may withdraw consent to the processing of personal information about you in your capacity as data subject, or of your child or that of the minor under your guardianship at any time, and should you wish to do so, you must provide Dr De Villiers with reasonable notice to this effect. Please note that withdrawal of consent is still subject to the terms and conditions of any contract that is in place between yourself and Dr De Villiers. Should the withdrawal of consent result in the interference of legal obligations, then such withdrawal will only be effective if Dr De Villiers agrees to same in writing. Dr De Villiers specifically draws to the attention the fact that the withdrawal of consent may result in him being unable to provide the requested information and/or products and/or services and/or medical treatment and/or other benefits. Further, please note that the revocation of consent is not retroactive and will not affect disclosures of personal information that have already been made. In order to withdraw consent, please contact Dr De Villiers at firstname.lastname@example.org
Where personal information about you in your capacity as data subject, or of your child or that of the minor under your guardianship has changed in any respect, you are encouraged to notify Dr De Villiers so that his records may be updated. Dr De Villiers will largely rely on you to ensure that personal information is correct and accurate.
You have the right to access your personal information or that of your child or the minor under your guardianship that Dr De Villiers may have in his possession and you are entitled to request the identity of which third parties have received and/or processed personal information for the purpose agreed to. Please note however, that any request in this regard may be declined if:
- the information comes under legal privilege in the course of litigation,
- the disclosure of personal information in the form that it is processed may result in the disclosure of confidential information,
- giving access may cause a third party to refuse to provide similar information to Dr De Villiers,
- the information as it is disclosed may result in the disclosure of another person’s information,
- the information contains an opinion about another person and that person has not consented, or
- the disclosure is prohibited by law.
Requesting access and lodging of complaints
Please submit any requests for access to your personal information or that of your child or the minor under your guardianship in writing to Dr De Villiers at email@example.com With any request for access to personal information, Dr De Villiers will require you to provide personal information in order to verify identification and therefore the right to access the information. There may be a reasonable charge for providing copies of the information requested.