Treatment agreement and privacy statement

Practice for Mesology and Orthomolecular Therapy Dafna Suskind 12-12-2024

Practice address: Hillegomstraat 12-14, 1058LS and Schalkburgerstraat 17, 1092JW Amsterdam
Email dafna@mesoloog.amsterdam
Phone 06-28733712
Kamer van Koophandel 63507870

Consent requirement

Any medical (treatment) action requires the client’s consent. Thus, the client must give consent for the initiation or continuation of treatment. The therapist must inform the client in such a way that the client is able to make a well-considered decision. For non-invasive operations, consent may be assumed to be given.

Privacy Statement

For proper treatment, it is necessary for me as your treating therapist to keep a file. This is also a legal obligation imposed by the Medical Treatment Agreement Act (WGBO). Your file contains notes on your state of health and data on the examinations and treatments carried out. In accordance with the legal retention period, this file is kept for a total of 20 years. The financial records 7 years.

For privacy statement and terms and conditions, please visit the website: www.mesoloog.amsterdam

Also included in the file are data that are necessary for your treatment and that I may and if necessary, after your explicit consent, have requested from another health care provider such as the family doctor.

I do my best to ensure your privacy. Among other things, this means that I:

handle your personal and medical information with care,
ensure that unauthorized persons do not have access to your data
As your treating therapist, I am the only one who has access to the data in your file. I have a legal duty of confidentiality (professional secrecy).
The data from your file may also be used for the following purposes:
- To inform other health care providers, such as when therapy is completed or when you are referred to another practitioner. This is done only with your explicit consent
- For use for observation, during my absence
- For anonymized use during peer review.
- A small portion of the information from your file is used for financial records so that I, or my administrator can prepare an invoice.

If I want to use your data for any other reason, I will inform you first and ask for your explicit consent.

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Privacy in relation to your healthcare bill

The care bill, which you will receive following your appointment, contains data required by health insurance companies so that you can claim this bill from your health insurance company. This data includes your:

Name, address and residence;
Date of birth;
Date of treatment;
Invoice number;
A brief description of the treatment; ‘24008’ Treatment Mesology or ‘24000’ Treatment Orthomolecular Therapy
The cost of the consultation.

Consent in the case of minors

For minors between the ages of 12 and 16, consent is required from both the child and parents. Treatment of children under 12 requires parental consent only. For both categories, if the parents are divorced, consent is required from both or either parent if the latter parent is charged with parental authority. In the latter case, the parent who is not charged with parental authority is entitled to general information from the therapist.

For more information regarding the treatment agreement, I refer to the “Medical Treatment Agreement Act (WGBO).” This can be viewed on the website https://hulpgids.nl/recht/wettelijke-regelingen/wgbo.

Explanation

In order to comply with the conditions, which as of May 25, 2018 are associated with the introduction of the privacy law (General Data Protection Regulation – AVG), from April 23, 2018 (at your next appointment) you will be asked once to indicate in writing that you have taken note of the data stored for your mesological treatment and to consent in writing to the storage of this data. At the start of your appointment, you will have the opportunity to digitally sign the consent form so that your written consent can be added to your file.

Of course, you can withdraw this consent at any time.

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Information

General terms and conditions
Complaints procedure
Privacy statement

Affiliated with:

Practice

Hillegomstraat 12-14
1058LS Amsterdam

Schalkburgerstraat 17
1092JW Amsterdam

Contact

+31 6 28733712
dafna@mesoloog.amsterdam