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DATA PRIVACY CONSENT FORM

Cordlife Medical Phils., Inc. (“Cordlife”) values the privacy and security of your personal data that you have entrusted to us.

Cordlife aims to comply with the Data Privacy Act (DPA) of 2012 and cooperates fully with the National Privacy Commission (NPC). Cordlife is committed to meeting both your personal privacy, which is important to us, and ensuring that our genuine and legitimate interests as a consumer healthcare company and our ability to fully and effectively carry out our responsibilities as such are met.

In this Form, the terms, “personal data” and “personal information” are used interchangeably. When we speak of “personal data”, the term includes the concepts of personal information, sensitive personal information, and privileged information. The first two are typically used to distinctively identify you. For their exact definitions, you may refer to the text of the DPA by visiting the website of the NPC, https://www.privacy.gov.ph.

Processing of Personal Data

A. Collection of Information

We collect your personal data that include those you provide us in our official forms/documents, including, but not limited to the following: (1) Client Registration Form; (2) Consent and Release Form; (3) Client Service Agreement; (4) Mode of Payment Form; (5) Cord Blood Network Form; (6) Cordlife Transplant Care; (7) Cordlife Shield 360°; (8) Health History Questionnaire; (9) HIV Testing Form; (10) Checklist for Closure of Banking Enrolment; (11) Special Informed Consent; and (12) Pre-Enrolment Agreement and Informed Consent.

We also collect personal data of your child as depicted in the latter’s Certificate of Live Birth as well as his/her pertinent medical information as a result of the required Infant Health Check.

Upon application and/or registration, we may collect information about you, including but not limited to your full name; date of birth; mobile, home and office telephone numbers; email address; occupation; nationality; tax identification number; mailing address and bank and credit card details.

We collect your health history via the Health History Questionnaire. We also collect details on your obstetrician/gynecologist/certified nurse/midwife; your hospital name and location, and your estimated date of delivery or date of elected caesarian operation.

In relation to your preferred mode of payment, we may collect your bank and credit card details.

B. Access to Information

Your personal information is accessed and used by Cordlife, specifically Sales Department, Operations Department/Customer Service, Accounting and Finance, Fulfillment and Laboratory personnel who have legitimate need to access such data for the purpose of carrying out their mandated duties.

We use and share your information as permitted or required by the Data Privacy Act of 2012 and other applicable laws to pursue our legitimate interests as a consumer healthcare company, including a variety of testing, assessment, quality assurance, insurance, administrative, and statistical purposes.

We may use your information to pursue our legitimate interests as a consumer healthcare company for any or all of the following purposes:
  1. evaluating eligibility for enrolment;
  2. ensuring the safe collection process and subsequent use of the cord blood and cord tissue;
  3. preparing the birth report;
  4. recording, generating and maintaining client records;
  5. establishing and maintaining client information systems; and
  6. as may be required by law.


C. Sharing of Information

We may share or disclose your personal information to others for any or all of the following purposes:
  1. transporting the umbilical cord blood or lining via a third-party courier;
  2. testing the maternal blood sample;
  3. transferring the umbilical cord blood or lining based on your requirement;
  4. processing your payment;
  5. procuring insurance plans for you in applicable cases; and
  6. reporting and/or disclosing information to the NPC or the Department of Health (DOH) when required by law.

Data Protection
Cordlife implements reasonable and appropriate organizational, physical, and technical security measures for the protection of personal data which it collects, and ensures that its employees and agents acting under its authority and who have access to personal data, do not process them except upon Cordlife’s instructions, or as required by law.

Any data security incident or breach that comes to the knowledge of Cordlife will be recorded and reported as required by law. Cordlife will take all necessary and reasonable steps to address such incident or breach and mitigate any negative effect of such incident or breach. If there is strong suspicion that an incident affects your personal information, Cordlife will notify you of such incident in a manner required by law.

Retention
Cordlife retains your data only for as long as necessary for the fulfillment of the terms of our Agreement. Upon termination (prompted by you or your child upon reaching the age of majority), we retain your data for ten years from termination date pursuant to AABB standards.

Confidentiality
After successfully completing your banking enrolment and the umbilical cord blood or lining have been deemed eligible for storage, your personal information and that of your child remains private and confidential.

Our employees shall operate and hold personal data under strict confidentiality. They are required to sign non-disclosure agreements; have received training on the company’s privacy and security policies; and were issued the necessary security clearances.

Your Rights as a Data Subject
Pursuant to the DPA, you may object to the processing of your personal data, request to access your personal information, and/or have it corrected, erased, or blocked on reasonable grounds. For the details of your rights as a data subject, you can get in touch with our Data Privacy Officer at contact details below or with the National Privacy Commission at https://www.privacy.gov.ph. Cordlife will consider your request and reserves the right to deal with the matter in accordance with the law.

Contact Information
If you have further questions or concerns regarding your privacy rights, this Consent Form or any matter regarding the Data Privacy Act of 2012, you may contact our Data Privacy Officer through the following details:

The Data Privacy Officer
Tel. No.: +632 332 1888 ext. 1105
Email Address: dpo.ph@cordlife.com

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Health History Questionnaire



All information herein will be kept strictly confidential, save for declaration required by law and/or for transplant purposes. We request your kind understanding that sensitive questions are asked to help us make the cord blood collection process and subsequent use safe.


All "Yes" answers require an explanation. Please use the space allocated at the end of this questionnaire.

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12. In the past 5 years, have you:

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Travel History
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Genetic/ Family History
Has your baby’s biological father, his family members or any of your family members (biological parents and siblings) had:
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*The informed consent below applies to all Cordlife’s banking services you have enrolled for this pregnancy. The maternal blood test results and Medical Director’s decision may be required to determine eligibility of storage.

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I understand that appropriate confidentiality will be maintained for all patient records concerning the Service, but that the Department of Health, or other government agencies may inspect records in accordance with applicable laws or regulations. I therefore certify that I have answered the above questions truthfully and to the best of my knowledge.
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Minimum amount to pay is 25,000
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Please transfer to below account and upload transaction record

CMPI BDO Account (004058010066)
Please transfer to below account and upload transaction record

CMPI BPI account (2281-0000-82)
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