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Consenting to making your personal and sensitive personal information available to InLife Health Care, its affiliates, related entities and partner/ accredited hospitals, clinics, and wellness centers (including their officers, employees, service providers, subcontractors as well as members of their medical staff, house staff, doctors, nurses, allied health care personnel and other clinical staff– “InLife Health Care Related Entities”), and permitting InLife Health Care and InLife Health Care Related Entities to make your personal and sensitive personal information available to (a) third parties who provide products and services to InLife Health Care for the purposes described above; (b) regulatory authorities and government agencies such as, but not limited to, the Insurance Commission, the Anti-Money Laundering Council and the Department of Health, and (c) your employer and/or the principal member to which you are a dependent, where required or permitted by law or contract. Provided, that the sharing of personal and sensitive personal information to InLife Health Care Related Entities shall be subject to appropriate data privacy agreements and the implementation of security measures.1. Consenting to making your personal and sensitive personal information available to InLife Health Care, its affiliates, related entities and partner/ accredited hospitals, clinics, and wellness centers (including their officers, employees, service providers, subcontractors as well as members of their medical staff, house staff, doctors, nurses, allied health care personnel and other clinical staff– “InLife Health Care Related Entities”), and permitting InLife Health Care and InLife Health Care Related Entities to make your personal and sensitive personal information available to (a) third parties who provide products and services to InLife Health Care for the purposes described above; (b) regulatory authorities and government agencies such as, but not limited to, the Insurance Commission, the Anti-Money Laundering Council and the Department of Health, and (c) your employer and/or the principal member to which you are a dependent, where required or permitted by law or contract. Provided, that the sharing of personal and sensitive personal information to InLife Health Care Related Entities shall be subject to appropriate data privacy agreements and the implementation of security measures.
After every evaluation, InLife Health Care shall generate reports from the personal and sensitive personal information collected. For this purpose, your personal and sensitive personal information will generally be stored by InLife Health Care for a period of ten (10) years unless sooner requested to be deleted in writing (but subject to limitations) or unless a different period is provided by law (see: ‘How Long Will InLife Health Care Keep Your Data’).
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Authorizing your health care provider, hospital, clinic or doctor (collectively “health care provider”) to process and release any of your personal and sensitive personal information and related documents that the health care provider has in its possession (specifically including records or information relating to any of your medical history and physical condition, or any treatment you have received in connection with your HMO coverage as well as a summary thereof) to InLife Health Care or its authorized representatives.
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Authorizing InLife Health Care to release the personal and sensitive personal information stated in the immediately preceding number to (i) Shell Health; (ii) the principal member to whom you are dependent, if applicable, for the evaluation of your medical claim; and (iii) InLife Health Care Related Entities.
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Consenting to the processing of your personal and sensitive personal information as provided under applicable laws, regulations, and InLife Health Care’s Privacy Policy, as stated in its website (www.insularhealthcare.com.ph/privacy-policy/)
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Warranting that before providing InLife Health Care with the personal and sensitive personal information of your next of kin, dependent or legal representative, you have obtained their consent (a) for you to collect the same; (b) for you to share them with InLife Health Care and the third parties that InLife Health Care are dealing with as provided above; and (c) for the processing of their personal and sensitive personal information by InLife Health Care, InLife Related Entities and third parties as provided herein, and for the purposes stated herein.
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Acknowledging that the personal and sensitive personal information that you have provided will be retained by InLife Health Care and InLife Related Entities as prescribed by law, or as long as necessary for the purpose of maintaining your medical records and to comply with applicable laws, rules and regulations. Through this form, you have been made aware that you and your next of kin, dependent or legal representative are entitled to certain rights in relation to the personal and sensitive personal information that may be collected from you and your next of kin, dependent or legal representative, including the right to access, correction, and to object to the processing of the same. You have been made aware that a more detailed description of your rights under Republic Act No. 10173 or the Data Privacy Act of 2012 and its Implementing Rules and Regulations may be accessed and downloaded at www.privacy.gov.ph. You have likewise been made aware that should you have any privacy concern regarding your personal data, you may consult InLife Health Care’s Data Protection Officer at dataprivacy@insularhealthcare.com.ph or Tel: 8813-0131 loc 8505, or the National Privacy Commission at www.privacy.gov.ph
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Confirming that you understand the foregoing and that you are voluntarily giving your consent to the processing of your personal and sensitive personal information under the terms and conditions provided above. You understand that the consent you are giving through this form is in addition to any other consent that you may have already given InLife Health Care and its affiliates regarding the processing of your personal and sensitive personal information (e.g. in relation to HMO coverage/ availment, examination, diagnosis, treatment or procedure). You likewise understand that the consent you have given shall remain in full force until revoked in writing except to the extent that action has already been taken based therein.