1. Dr Sheena Geness is a general practitioner providing general medical services to patients and as part of its business functions and the practice collects and processes Personal Information.
2. The practice collects, stores, uses, handles, processes, transfers, retains, archives and otherwise manages Personal Information.
3. In order to discharge this duty, the Reasonable Party requires my express and informed permission to collect and process my Personal Information or that of my dependent/s and adult dependents who are unable to provide their own consent.
4. PURPOSE: I consent with the practice sharing my personal information with selected healthcare providers, medical schemes, administrators, service providers and any contracted third parties necessary for the provision of any service to me. I further agree that Personal Information provided to the practice will be used to ; -give effect to my contractual relationship with the practice and to conduct its operations for the provision of medical services to me and/or my dependent/s and for any referrals to other specialists or service providers.
-provide a report to the practice’s indemnity or insurance providers and the recipient will be notified of the need to protect the confidentiality of the personal information
-comply with obligations required by any legislation affecting this practice
-protect the legitimate interests of the practice, myself and any third parties
-store my personal health information in a secure manner in any format
-furnish my medical scheme for services provided to me or my dependent/s
-for medical research purposes or the teaching of medical students
-to access mine or my dependent/s medical scheme benefits
-to provide emergency medical services to me or my dependent/s
-retain in terms of the statutory and ethical limits
-transfer to specialists who will access, view and store my personal health information. The practice cannot guarantee the security or integrity of any information that I transmit to the practice online or otherwise and I agree and understand that I do this at my own risk
-in connection with legal proceedings including debt collection I understand and agree that if the practice does not have my or my dependent/s consent, the practice will not be able to commence treatment and cannot share Personal Information with any specialists/contractors/other providers to optimize my healthcare treatment.
5. WITHHOLDING CONSENT: I understand that I can withhold consent to the practice collecting and processing my Personal information. I agree in this case that the practice will not be able to provide medical services to me.
6. STORAGE OF PERSONAL INFORMATION: My Personal Information will be stored electronically or in hand copy in a safe and secure environment. Hard copies of Personal Information will be stored and retained under lock and key. After I am no longer an active patient, my Personal Information will be retained for as long as the law or the practice’s indemnity/Insurance providers require it.
7. 7.1 RETENTION OF PERSONAL INFORMATION: The practice will not retain Personal Information for longer than is necessary and for the required purpose. The exceptions to the above principle specifically provided in the POPIA are where-
7.1.1. the retention of the record is required or authorized by law;
7.1.2. the practice reasonably requires the record for lawful purposes related to its functions or activities;
7.1.3. the retention of the record is required in terms of an agreement between the practice and myself; or
7.1.4. the record is retained for historical purposes, with the practice having established appropriate safeguards against the record being used for any other purpose.
7.2 When the Personal Information is no longer required it shall be destroyed or deleted in a manner that prevents their reconstruction in an intelligible form.
8. INTENDED RECIPIENTS: I agree the intended recipients of my Personal Information are me, health care providers, specialists, medical technicians and pathologists (including practice staff, medical schemes/administrators, facilities, medical suppliers, researchers, emergency medical service providers. Such disclosures will always be made between the practice and recipient to comply with strict confidentiality and security conditions as contained in POPI Act.
9. TRANSFER OUTSIDE SOUTH AFRICA: I agree to the practice transferring any Personal Information outside the borders of South Africa to its indemnity providers that has in place similar privacy laws to POPIA or the recipient is bound contractually to no lesser terms of POPIA
10. I understand that I have the right to have my Personal Information processed in accordance with the eight conditions of lawful processing of Personal Information as set out in POPIA.
11. OBJECTION TO PROCESSING: I understand that I have the right to object to the practice processing my Personal Information, on reasonable grounds. On receipt of my objection with reasons, the practice shall hold any further processing of my Personal Information until my objection has been addressed, resolved, withdrawn or upheld and accepted by the practice. If my objection is withheld, no further processing of my Personal Information shall be done by the practice. I acknowledge that the practice also reserves the right to discontinue any medical treatments/advise/interventions.
12. RIGHT TO WITHDRAW CONSENT: I understand that I have the right to withdraw my consent to the practice processing my Personal Information, at any time provided any processing before such withdrawal or if the processing is necessary for conclusion or performance of a contract to which I am a party will not be affected. I understand that I can revoke consent for any specific health care provider, or person who has access to my Personal Information. Once this information is captured and updated, my personal information will no longer be shared. I understand and agree that this may affect my treatment/ healthcare and I take full responsibility for my decision.
13. ACCESS: I have the right at any time to request details of any of my Personal Information that the practice holds, such request shall be made in writing to the Information Officer.
14. CORRECTION/DELETION: I have the right to request the practice, to correct and/or delete my Personal Information that is inaccurate, irrelevant, excessive, out of date, incomplete, misleading. That any changes to my personal information must be communicated to the practice immediately so these changes can be updated on their systems. The practice will not be liable for inaccurate information on our systems as a result of my failure to inform us of my updated personal information. I have the right to request the practice to destroy or to delete a record of my Personal Information that the practice is no longer authorized to retain in terms of any other law.
15. CORRECTION OF PERSONAL INFORMATION: I acknowledge that whilst the practice will always use its best endeavors to ensure that my Personal Information is reliable, it is my responsibility to advise the practice of any changes to my Personal Information, as and when these changes may occur. The practice will not be liable for inaccurate information on our systems as a result of my failure to inform us of my updated personal information.
16. MARKETING: The practice undertakes not to distribute my Personal Information to any third party for the purpose of marketing to me third party’s supplies, or other products. Notwithstanding this, I agree the practice may process my Personal Information for providing me with products/and services. Should I not wish to receive these communications, I will provide the practice with a detailed opt out, listing the type of communication that I do not wish to receive addressed to the
Information Officer at drsgeness@gmail.com.
17. I agree:
17.1 I will not hold the practice responsible for any loss (whether direct or indirect)
that may arise from the use of my Personal Information.
17.2 I may not hold the practice responsible for any loss that may result from the
incorrect use or disclosure of the information by any health care provider to whom
the practice has provided the Personal Information
17.3 to give permission for the practice to my medical scheme/ or administrator details of my diagnosis and clinical information required
17.4 that I had an opportunity to read the terms and conditions (or they have been read to me) and I fully understand the consequences of these terms and conditions. I had sufficient opportunity to ask questions about this consent form and questions, answered to my satisfaction by the practice.
18. My consent is provided of my own free will without any undue influence from any person whatsoever.
19. I confirm that I have permission of my dependent/s to give their consent, where such consent has been provided and I indemnify the practice against this.
20. THE PRACTICE INFORMATION OFFICER DETAILS ARE:
DR SHEENA GENESS
Contact details are as follows:
PHONE: 011 3360982
EMAIL: drsgeness@gmail.com

EMAIL: info@drsgeness.co.za

POSTAL ADDRESS: Postnet Suite 273, Private bag X1, Melrose Arch, 219