Health Screening Appointment

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Please provide information that matches your passport exactly, so we can locate or create your medical record.

First Name

Last Name

Date of Birth (yyyy/mm/dd)

Gender

Nationality

Passport No. or Foreign Registration Card No.

Code

Phone Number Optional

Consent for Information on the Collection and Use of Personal Information

In accordance with Article 15(1)(2), Article 17(1)(2), and Article 18(2)(2) of the Personal Information Protection Act, personal information may be collected, used, and provided without the data subject’s consent if there is a legal basis.

Purpose of Collection	Reservation
Items Collected	Patient registration number, Passport number, Name, Gender, Date of birth, Nationality, Samsung Medical Center ID, Contact number, Email address, Private Insurance, Symptoms & Medical Services Required.
Retention and Use Period	In accordance with Article 15 of the Enforcement Regulations of the Medical Service Act, medical records shall be retained for 10 years from the last date of treatment and may be extended once for an additional period
Legal Basis	Article 22 of the Medical Service Act and Article 14 of its Enforcement Regulations

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