醫生 中文姓名 *英文姓名 *電話 (香港) *電郵地址 *專科類別 *外科內科腦外科腦神經科眼科耳鼻喉科牙醫呼吸系統科心胸肺外科心臟科血液及血液腫瘤科腸胃肝臟科腎病科泌尿科婦產科脊醫骨科內分泌及糖尿科免疫系統過敏科感染及傳染病科腫瘤科放射科核子醫學科兒科小兒外科老人科風濕病科皮膚科性病麻醉科復康科精神科病理學職業醫生社會醫學科急症科深切治療科普通科門診家庭醫學其他 other (請說明 please specify)其他 other (請說明 please specify)合作轉介 (可選擇多於一項) *個案轉介救援工作(國際、內地或本地)其他 other (請說明 please specify)其他 other (請說明 please specify)備註Checkboxes *本人已閱讀「收集個人資料聲明」,並完全明白其內容。個人資料收集聲明: 1. 本人同意,本會可定時向本人以不同聯絡方式(包括但不限於,電話、電郵、郵寄、社交媒體及傳真等)(統稱 “聯絡方式”) 發出各類通訊(包括但不限於,最新消息、會議、活動通知、義工服務、募捐等相關資料)(統稱 “通訊”)。本會對本人的個人資料保密。 2. 本人茲授權,本會可能會把本人的個人資料提供及披露給予第三方,以上述聯絡方式發出各類通訊。 3. 本會會員發展部主任為資料保護專員。如以上個人資料有任何更改,請即通知會員發展部。如欲取消上述(1)及/或(2)安排,請書面通知會員發展部;會員發展部在收到有關通知後,即辦理取消手續。 4. 根據《個人資料(私隱)條例》(香港法例第486 章),如欲查閱本會所持有的個人資料,請填妥 “查閱資料要求表格” (OPS003),並交回會員發展部;會員發展部可就有關查閱收取合理費用。 Personal Information Collection Statement : Personal Information Collection Statement : 1.I agree that this will be timed to me in a different way contact (including, but not limited to, telephones, email, mail, social media, and fax) (collectively, the "Contact") issued various types of communications (including but not limited to, the latest news , Meetings, event notices, volunteer services , fundraising and other related information) ( collectively, the " Newsletter " ) . This will maintain the confidentiality of my personal data. 2.I hereby authorize that this Association may give my personal information to third parties for the purpose of providing and disclosing my personal information in the manner described above . 3.The director of member development department is Data Protection Commissioner. If there is any change in the above personal information, please inform Membership Development Department . To cancel as above (1) and / or (2) arrange, please notify in writing the Ministry of Membership; Membership Development Department after receiving the notice, namely for cancellation procedures. 4.According to (Cap. 486), such as the desire access to personal data held by the club, please fill in the "Personal Data (Privacy) Ordinance," "Data Access Request Form" (OPS003), and return the membership development department; Member development may charge a reasonable fee for such inspection.NameSubmit