Medizinische Hochschule Hannover : Polyclinic

Appointments at the ENT Polyclinic

Salutation:

Your title:

First name:

Last name: *

Date of birth: *

E-mail address: *

Phone number: *

Is this your first visit?:

Are you here because of complaints? If yes, where do you have these complaints?:

Ear

Nose

Throat

I have taken note of the following information obligations, which fully inform me about the use of the data provided via the contact form: My personal data will be stored and processed on the server of the MHH data center in accordance with data protection regulations, in particular the GDPR. Employees of the Clinical Department of ENT at MHH have access to the data. My data will be used to contact me personally and to clarify my request, and if I send files (images and documents) via this form, I give my consent for this data to be processed. This also applies to special categories of personal data transmitted by me, such as health data. The MHH processes these in accordance with Art. 9 para. 2 lit. b) GDPR exclusively for the purpose of contacting you and processing your request. My personal data will only be passed on within the MHH to those departments and persons who need this data to fulfill contractual and legal obligations or to implement the legitimate interests of the MHH. My personal data will not be passed on to a third country or an international organization. Once my data has been collected by the MHH ENT Clinical Department, it will be stored for as long as is necessary to fulfill the purpose for which it was collected. As a rule, this means that my personal data will be deleted or anonymized once the request has been completed. Existing retention obligations and periods will be observed. In the event of a revocation, my data that I have provided via the contact form will be deleted. In the data protection declaration linked under the form, I have taken note of my legal rights with regard to the personal data concerning me in accordance with the GDPR. *

Data protection information

By activating the checkbox and submitting the form, I have taken note of the following information obligations, which fully inform me about the use of the data provided via the contact form: My personal data will be stored and processed on the server of the MHH data center in accordance with data protection regulations, in particular the GDPR. The Clinical Department of ENT at MHH has access to the data.

Purpose of data collection
My data will be used to contact me for the purpose of making an appointment.

If I send files (images and documents) via this form, I give my consent to the processing of this data. This also applies to special categories of personal data transmitted by me, such as health data. In accordance with Art. 9 para. 2 lit. b) GDPR, MHH processes these exclusively for personal healthcare purposes.

Disclosure of the data
My personal data will be disclosed

within the MHH exclusively to those areas and persons who need this data to fulfill contractual and legal obligations or to implement the legitimate interest of the MHH.

Storage
My data will be stored by the Clinical Department of the MHH for as long as necessary to fulfill the purpose for which it was collected. As a rule, this means that my personal data will be deleted or anonymized once the request has been completed. Existing retention obligations and periods will be observed.

Revocation
In the event of revocation, my data that I have provided via the contact form will be deleted.

Legal
In the data protection information linked here, I have taken note of the rights regarding the personal data concerning me in accordance with the GDPR.