Who is collecting it
Vein Centres of South Africa, practising as Dr Johan Blignaut, Specialist Surgeon, is the responsible
party. Our Information Officer is Dr J Blignaut, Suite 7, Block B, Cedar Medical Centre, Stinkwood Close,
Fourways, Sandton, 2539, fourways@veinsurgery.co.za.
What we collect on this form
- Identifying information: your title, names, surname, identity or passport number, date of birth, sex, language, and those of the main member if that is not you.
- Contact details: physical and postal address, telephone numbers and email address.
- Medical scheme name, plan, membership number and dependant code, and your employer.
- Next of kin name, relationship and contact number.
- Basic health information: your height and weight, and how you were referred to us.
Health information is special personal information under POPIA and receives additional
protection. We may process it because we are a medical professional bound by a duty of confidentiality
providing you with care, and with your consent.
Why we collect it
To register you as a patient, verify your medical scheme benefits, obtain pre-authorisation where required, render and collect accounts, and provide you with medical care. We also keep the clinical records we are professionally and legally required to keep.
Is it voluntary?
Yes. You are not obliged to complete this form. However, if you do not provide the information we ask
for, we may be unable to treat you safely or to submit claims to your scheme on your behalf.
Who we share it with
Only where necessary: your medical scheme or its administrator and your gap cover insurer where you ask
us to; other practitioners involved in your care; our practice management, billing and IT service providers,
who are contractually required to protect it; and anyone we are required or permitted by law to share it
with. We do not sell your information. Some service providers may process information outside South Africa,
and where that happens we take reasonable steps to ensure an appropriate level of protection.
How long we keep it and how it is protected
This form is submitted over an encrypted (HTTPS) connection. Clinical records are retained for the periods
required by South African law and the Health Professions Council of South Africa. We take appropriate,
reasonable technical and organisational measures to protect your information as section 19 of POPIA
requires.
Your rights
You may ask what information we hold about you and request a copy; ask us to correct or delete
information that is inaccurate, out of date, incomplete or misleading; object to processing on reasonable
grounds; and withdraw consent, without affecting processing already carried out. Some rights are limited
where we are legally obliged to retain clinical records. Contact our Information Officer to exercise any of
these.
Complaints
Please contact our Information Officer first. You may also complain to the Information Regulator (South
Africa): inforegulator.org.za,
POPIAComplaints@inforegulator.org.za.
Full details are in our Privacy & POPIA
Notice. Please do not use this form for urgent medical problems — contact your
nearest vein centre or, in an emergency, your nearest emergency service.
