PATIENT SUPPORT PROGRAM
ONCOGENETIC PATIENT SUPPORT PROGRAM (OPSP) APPLICATION
As authorized with Oncogenetics, the information contained in the patients within the scope of the patient and the special received information approved with the purchase of the system related to the training of the European unit (EU) analysis applications, is a support system suitable for educational purposes in order to provide access to children's and cute devices.
As the owner of Oncogenetics, reserves the right to terminate, discontinue the Oncogenetics Patient Support Program at any time and to do so with entitlement.
Patient name-surname and T.R identification number or Passport No are needed.
The formula applied for your application will be evaluated for inclusion in the application and will be valid for the system to be used.
I know and agree to carry out my personal data, including my comprehensive health data for testing and analysis services, with overseas health workers, hospitals, control and similar institutions and organizations owned by Onkogenetics. I will forward this item to you and that all my personal data related to the use tests can be purchased from the company, intended for use, designed and designed from the healthcare service, and that I can review the candidate for approval and give consent from this.
I have read, understood and accept the terms and conditions.
Patient TR No
The hospital/institution where you are treated or where your disease is followed/evaluated
Person making the payment
Your marital status?
If you have children, your children's age?
City you reside in?
Your education status?
What is your job?
Your individual monthly net income?
Do you have a vehicle?
What is your average monthly billing expenses?
What is your monthly household total income?
Do you own the house you live in? If not, what is your monthly rental expense?
For the confirmation of your declaration information, we request you to upload the PDF file of your SSI service statement to the system.
Time is Up!