Patient notice template
A template to adapt and give to your patients, published in your name as controller.
Template to adapt. This is not a medi.tn notice: it is a template made available to the physician, who is the controller of their patients' data. Replace the bracketed passages with your practice's details, then display the notice in your waiting room, hand it to your patients, or publish it on your website.
It is for you to check that the content matches your actual practice: a notice describing processing different from what you carry out does not protect you. If in doubt, have it reviewed by counsel.
This is a courtesy translation. The French version is the reference text — see Modèle de notice patient.
Protection of your personal data
Who processes your data?
Dr [Physician's name], [speciality], practising at [practice address], is the controller of your personal data.
Contact: [telephone] — [email address]
What data is collected?
- Your identity and contact details: surname, first name, date of birth, address, telephone, email address.
- Your health data: reason for consultation, history, examinations, diagnoses, prescriptions, reports.
- Your coverage data: social security number, scheme, filière and CNAM documents where applicable.
- Amounts paid and billing documents.
Only the data necessary for your care is collected.
Why?
- To provide your medical follow-up and maintain your record.
- To manage appointments.
- To produce coverage documents and, if you are insured, the documents intended for the National Health Insurance Fund.
- To meet the legal and ethical obligations binding on the physician.
Your data is used for no commercial purpose and is sold to no one.
Who has access?
- The physician, bound by professional secrecy.
- [Practice staff, also bound by professional secrecy — delete if you practise alone.]
- [Other health professionals involved in your care, where necessary — adapt.]
- The National Health Insurance Fund, for only the data necessary for reimbursement, if you request coverage.
- The provider hosting the practice software, medi.tn, which acts solely on the physician's instruction and under contract, never using your data for its own purposes.
Your data is hosted in Tunisia and is transferred to no other country.
How long is it kept?
Your record is kept for [period chosen by the practice] from [your last consultation / to be specified], in accordance with the applicable retention obligations.
⚠ To be checked with your counsel. The retention period for medical records in Tunisia must be confirmed: do not adopt a period found online, as the periods commonly cited come from other countries.
What are your rights?
You may:
- access the data concerning you and obtain a copy;
- request the rectification of inaccurate or incomplete data;
- object, on legitimate grounds, to the processing of your data.
These rights are exercised with the physician, at the contact details above. Proof of identity may be requested. You will receive a response within one month.
Certain data cannot be deleted at your request where its retention is required of the physician by law or by professional ethics.
If you have a difficulty
If you consider that your rights are not being respected, you may contact:
National Authority for the Protection of Personal Data (INPDP) 1, rue Mohamed Moalla, 1002 Mutuelleville, Tunis, B.P. 525 Telephone: 71 799 853 / 71 799 711 inpdp@inpdp.tn
Notice drawn up on [date] by [practice name].