INFORMED CONSENT AND AUTHORISATION FORM FOR GENETIC DATA PROCESSING

HeartGenetics seeks your permission to process and analyse your pseudonymised Genetic and Self-Reported Information for wellness purposes only.

In accordance with the provisions of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 – General Data Protection Regulation, Law No. 58/2019 of 8 August, Law 12/2005 of 26 January, and the regulations set forth in Decree-Law 131/2014 of 29 August, as well as Rule 015/2013 from the General Health Directorate.

Please read all the contents of this document carefully. Feel free to request us more information should you have any questions. Please check that all information is correct. If you believe that everything is in order, and you agree with the proposal being made to you, then please tick the respective box on the checkout page.

I understand and willingly authorise HeartGenetics S.A. to process and analyse my self-reported Genetic Information in the context of analytical services related to wellness genetics.

I understand that the information that I will learn from this data analysis is not designed to independently diagnose, prevent, or treat any condition or to ascertain the state of my health in the absence of medical and clinical information.

I am aware and understand that measures will be implemented for the protection and confidentiality of my data and that at any time I have the right to access, update and/or delete my personal data. I further understand that my personal data will be stored by HeartGenetics, S.A. for a period of 75 years and in accordance with the applicable laws and regulations, notably on health and genetic information databases, and with the applicable ethical principles. I am also aware that HeartGenetics, S.A. is not authorised to disclose my personal data to third parties.

I am aware and understand that when I submit my Genetic Information to HeartGenetics, S.A., HeartGenetics, S.A. will tag it with an anonymous tag and will redirect it in an encrypted data flow into HeartGenetics, S.A. reporting/analytics system. HeartGenetics, S.A. and will not be able to retrieve my Genetic Information from its database, as the same is completely anonymized as from the first moment that I remit it to HeartGenetics, S.A. for the analytical service.

I have understood all the information given to me, and the implications and limitations of the genetic study that I will undertake.

I have had the opportunity to ask questions and discuss the capabilities, limitations, and possible risks of the genetic study with HeartGenetics personal. I am aware that, if I so wish, I may obtain professional genetic counselling before signing this informed consent.

What does “pseudonymisation” mean? Pseudonymisation means that we strip the data of information that could directly identify you (such as name, date of birth, and address) and connect any study information you provide by using a random code (for example a study ID). Any Genetic & Self-Reported Information you allow us to process and analyse will be associated with that code, not with your name.