The Remote-Virtual-Video Consultation tool on https://www.perfectsmilespa.com/ is an assessment tool we use for orthodontic services. The application enables a patient to submit records to our orthodontic team using smartphones. When all images are taken, they are automatically uploaded and emailed to the dental practice over an encrypted email service. The service is used by our orthodontic team to help them make orthodontic treatment recommendations only.
In certain rare instances, the upload of the patient images may not be processed in the usual way but Perfect Smile Spa takes the protection of the Patient’s personal information very seriously. Perfect Smile Spa processes the following Patient’s personal data: Sensitive personal data - First Name, Last Name, Age - Email address, Phone number,Type of device used by the Patient - Device Id - Pictures of the Patient’s mouth. Perfect Smile Spa does not collect or process the personal data from children under the age of 13, without the explicit consent from a parent or guardian.
Personal data access is restricted to the sole employees that need to access personal to perform the services described in the Service description. A regular review of access rights including IT security measures to protect the Patient’s personal data is undertaken at regular intervals. Perfect Smile Spa will not share the Patient’s personal data with the any third party companies for the purposes of sales and marketing activities. At anytime, the Patient can contact Perfect Smile Spa in order to exercise the following rights: - Right to access to Patient’s personal data - Right to modify or erase the Patient’s personal data, subject to the legal requirements applicable in the Patient’s country - Right to restrict to personal data processing - Right to oppose to personal data processing.
INFORMED CONSENT I have been given adequate time to read and have read the preceding information describing dental assessment using the The Remote-Virtual-Video Consultation tool on Perfect Smile Spa website. I understand the benefits, risks, alternatives and inconveniences associated with the assessment as well as the option of not taking the assessment. I have been sufficiently informed and have had the opportunity to ask questions and discuss concerns about dental assessment with my dentist. I acknowledge that Perfect Smile Spa have not and cannot make any guarantees or assurances concerning the outcome of my assessment and treatment recommendations. No assurances or guarantees of any kind have been made to me by my orthodontist or by Perfect Smile Spa.
I authorize my dentist to release my medical record and medical information in his/her possession: (i) to other licensed dentists/orthodontists and organizations employing licensed dentist/orthodontists, its representatives, employees, successors, assigns, and agents for the purposes of providing a more accurate assessment and/or treatment recommendation. I hereby consent to the disclosure(s) as set forth above. I will not, nor shall anyone on my behalf seek legal, equitable or monetary damages or remedies for such disclosure. I acknowledge that use of my Medical Records is without compensation and that I will not nor shall anyone on my behalf have any right of approval, claim of compensation, or seek or obtain legal, equitable or monetary damages or remedies arising out of any use such that comply with the terms of this Consent.
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