【Explanation about sending personal information】
Central Green Japanese Clinic Co., Ltd (hereinafter referred to as "this clinic") will send medical treatment results, health checkup result reports, and other documents related to medical treatment at this clinic (hereinafter collectively referred to as "personal information") by e-mail from this clinic. ), etc., we ask for the consent of the patient (hereafter referred to as "the patient" or "I").
The Clinic will ensure the protection of patient's personal information and will maintain patient's personal information in accordance with all relevant laws and regulations. The clinic will take appropriate and necessary measures to store, use, and transmit the personal information of patients, and will do its best to maintain and protect the personal information of patients.
[Consent Form for Sending Personal Information]
I, as a patient and provider of personal information, hereby confirm that I have requested DYM Health Check Up, medical services or treatment provided by this clinic. I give approval to and consent to this clinic for the following services.
1. I send my personal information. This clinic will provide and send my personal information to the email I provided below from the email address of this clinic [dymmedicalclinic@gmail.com] (hereinafter referred to as "Gmail"). I confirm and agree to it. When sending my personal information via Gmail, the clinic will lock the data file containing my personal information with a password. I understand that the password for accessing my personal information file will be sent by Gmail from this clinic separately from the email that sends personal information.
2.I have confirmed that there is a possibility of leakage by sending my personal information by Gmail. If my personal information is leaked and it is not the fault of this clinic, and/or if it is caused by my actions under my own responsibility, this clinic will protect my personal information You acknowledge and agree that you are not responsible or liable for any disclosure.
I understand the contents of the above explanation and consent form, and agree to the above business.
This Agreement shall remain in full force and effect unless otherwise specified in writing or revoked.