Protection of Personal Information Act (POPIA)

Consent for the processing and use of personal information by The Dental Collective, in accordance with the Protection of Personal Information Act 4 of 2013 (POPIA).

I understand and agree that:

The Dental Collective is a dental practitioner/specialist providing dental services to patients and, as part of its business functions, the practice collects and processes Personal Information.
The practice collects, stores, uses, handles, processes, transfers, retains, archives and otherwise manages Personal Information.
In order to discharge this duty, the Responsible Party requires my express and informed permission to collect and process my Personal Information, or that of my minor and adult dependants who are unable to provide their own consent.

Purpose

I consent to 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 conduct its operations for the provision of dental or specialist services to me and/or my dependants, and for any referrals to other specialists and service providers.
Provide a report to the practice’s indemnity or insurance providers, who 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/or 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 dependants.
Conduct medical research.
Access my or my dependants’ medical scheme benefits.
Provide emergency dental services to me or my dependants.
Retain information within statutory and ethical limits.
Transfer information to specialists who will access, view and store my personal health information. The practice cannot guarantee the security or integrity of any information I transmit online or otherwise, and I understand I do this at my own risk.
Use information in connection with legal proceedings, including debt collection.

I understand that if the practice does not have my or my dependants’ consent, it will not be able to commence treatment and cannot share my Personal Information with any specialists, sub-contractors, or other providers to optimise my healthcare treatment.

Withholding Consent

I understand that I can withhold consent to the practice collecting and processing my Personal Information. I agree that, in this case, the practice will not be able to provide dental services to me.

Storage of Personal Information

My Personal Information will be stored electronically or in hard copy in a safe and secure environment. Hard copies will be stored and retained safely 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.

Retention of Personal Information

The practice will not retain Personal Information for longer than is necessary for the required purpose. The exceptions specifically provided in POPIA are where:

The retention of the record is required or authorised by law.
The practice reasonably requires the record for lawful purposes related to its functions or activities.
The retention of the record is required in terms of an agreement between the practice and myself.
The record is retained for historical purposes, with appropriate safeguards against the record being used for any other purpose.

When the Personal Information is no longer required, it shall be destroyed or deleted in a manner that prevents its reconstruction in an intelligible form.

Intended Recipients

I agree that the intended recipients of my Personal Health Information are myself, healthcare providers, specialists, dental technicians and pathologists (including practice staff or their staff), medical schemes/administrators, facilities, dental suppliers, researchers, and emergency medical service providers. Such disclosure shall always be made between the practice and recipient under strict confidentiality and security conditions as contained in the POPI Act.

Transfer Outside South Africa

I agree to the practice transferring any Personal Information outside the borders of South Africa to its indemnity providers, where the recipient has privacy laws similar to POPIA or is bound contractually to no lesser terms than POPIA. I understand that I have the right to have my Personal Information processed in accordance with the eight conditions of lawful processing set out in POPIA.

Objection to Processing

I understand that I have the right to object, on reasonable grounds, to the practice processing my Personal Information. On receipt of my notice of objection with reasons, the practice shall hold any further processing until my objection has been addressed, resolved, withdrawn, or upheld and accepted by the practice. If my objection is upheld, no further processing shall be done. I acknowledge that the practice also reserves the right to discontinue treatment.

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 that any processing before such withdrawal — or processing necessary for the 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 healthcare provider or person who has access to my Personal Information. Once this is captured and updated, my information will no longer be shared. I understand and agree that this may affect my treatment, and I take responsibility for my decision.

Access

I have the right at any time to request details of any Personal Information that the practice holds. Such a request shall be made in writing to the Information Officer of the practice.

Correction and 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, or misleading. Any changes to my personal information must be communicated to the practice immediately so they can be updated. The practice will not be liable for inaccurate information on its systems resulting from my failure to update my personal information. I also have the right to request the practice to destroy or delete a record of my Personal Information that it is no longer authorised to retain in terms of any other law.

Correction of Personal Information

I acknowledge that, whilst the practice will always use its best endeavours 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 they occur. The practice will not be liable for inaccurate information on its systems resulting from my failure to inform it of my updated personal information.

Marketing

The practice undertakes not to distribute my Personal Information to any third party for the purpose of marketing that third party’s supplies or other products. Notwithstanding this, I agree the practice may process my Personal Information to provide me with the practice’s own 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 I do not wish to receive, addressed to the Information Officer at chris@smileway.co.za.

Acknowledgements

I agree that:

I will not hold the practice responsible for any loss (whether direct or indirect) that may arise from the use of my Personal Information.
I may not hold the practice responsible for any loss that may result from the incorrect use or disclosure of the information by any healthcare provider to whom the practice has provided the Personal Information.
I give permission for the practice to give my medical scheme or administrator details of my diagnosis and the clinical information required.
I had an opportunity to read these terms and conditions (or they were read to me), and I fully understand the consequences of these terms. I had sufficient opportunity to ask questions about this consent form, and they were answered to my satisfaction by the practice.
My consent is provided of my own free will, without any undue influence from any person whatsoever.
I confirm that I have permission from my dependant(s) to give their consent, where such consent has been provided, and I indemnify the practice against this.

Information Officer

The Practice Information Officer is Christopher Kerr-Peterson.

Email: chris@smileway.co.za