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Patient consent form

Print this form, have it signed by the patient and keep it at your institution. It is not uploaded to the site.

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Draft

This form is a draft. It must be reviewed by a legal adviser before use, and the bracketed items must be completed.

Patient information and consent form for the teaching use of respiratory sound recordings and clinical information

Respiratory Sounds Atlas (lungsoundatlas.com) · form version 2026-11-taslak-1

1. Purpose

We would like to share recordings of the sounds heard when your chest is listened to with a stethoscope, together with some information about your illness, with your identity hidden, as a "clinical case" on the Respiratory Sounds Atlas website (lungsoundatlas.com). The aim is to teach medical students and health professionals.

2. What will be shared

Chest auscultation sound recordings; your age group (for example 55–64) and sex; your complaints, medical history, examination findings, a summary of test results, the diagnosis, the treatment and the course.

3. What will not be shared

Your name and surname, national ID number, phone number, address, photograph, date of birth, hospital record number, and any recording of your voice or speech. The recordings and information are cleaned of these before they are sent to the site.

4. Who can see it

Only people who join the site declaring that they are health professionals or students in a health field, and the site editor. The case title and a two-sentence summary containing no identifying information may be publicly visible.

5. Storage

The information is stored on the servers of Google Firebase, the service that runs the site. These servers may be located outside Turkey.

6. Limits of use

The information is used only for teaching. It will not be used for scientific research, publication or commercial purposes, and it will not be sold or given to third parties.

7. Duration

For as long as the case remains published on the site.

8. Voluntary participation

Giving consent is entirely voluntary. Not giving consent will not affect your treatment in any way. You will not be paid and you will not be charged.

9. Withdrawing consent

You can withdraw your consent at any time by contacting the health professional who made the recording or the site at [contact email]. The case is then removed from the site within [period]. Copies of content viewed while it was published may not be fully retrievable.

10. Your rights

Under Article 11 of the Turkish Personal Data Protection Law (KVKK) you have the right to learn whether your data are processed, to request information, correction or deletion, and to object.

Patient's consent

I have read this information, or it has been read to me, and I understand it. My questions have been answered. Of my own free will, I consent to my chest auscultation recordings and my non-identifying clinical information being shared for the purpose described above.

Patient's full name
Signature
Date

If the patient cannot give consent: legal representative

Full name
Relationship to the patient
Signature
Date

Health professional who made the recording

Full name and title
Institution
Signature
Date

This form is kept at the institution where the recording was made. It is not uploaded to the site. When submitting the case, the health professional declares that consent was obtained with this form version (2026-11-taslak-1).