{"id":563,"date":"2026-07-05T19:11:26","date_gmt":"2026-07-05T19:11:26","guid":{"rendered":"https:\/\/dekernleiden.nl\/consent-form\/"},"modified":"2026-09-29T13:20:10","modified_gmt":"2026-09-29T13:20:10","slug":"consent-form","status":"publish","type":"page","link":"https:\/\/dekernleiden.nl\/en\/consent-form\/","title":{"rendered":"Consent form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; next_background_color=&#8221;#ffffff&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;RGBA(255,255,255,0)&#8221; background_image=&#8221;https:\/\/dekernleiden.nl\/wp-content\/uploads\/2026\/04\/praktijkKern.webp&#8221; z_index=&#8221;446&#8243; min_height=&#8221;22vw&#8221; min_height_tablet=&#8221;22vw&#8221; min_height_phone=&#8221;22vw&#8221; min_height_last_edited=&#8221;on|phone&#8221; bottom_divider_style=&#8221;wave2&#8243; bottom_divider_height=&#8221;30px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;||20px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_font_size=&#8221;22px&#8221; header_font_size=&#8221;36px&#8221; text_orientation=&#8221;center&#8221; header_font_size_tablet=&#8221;36px&#8221; header_font_size_phone=&#8221;36px&#8221; header_font_size_last_edited=&#8221;on|desktop&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>Consent form<\/h1>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; ul_line_height=&#8221;1.8em&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>De Kern midwifery practice will be extremely careful in dealing with personal data of her patients. We adhere to the rules and laws of the GDPR, the general data protection regulation (AVG in Dutch). Without your consent to make (careful) use of your personal data, we cannot treat you at our midwifery practice.  <\/p>\n<p>More information about which data it concerns, what we do with your personal data and what your rights are, is given in our <a href=\"https:\/\/dekernleiden.nl\/en\/privacy-statement\/\" target=\"_blank\" rel=\"noopener\">privacy statement<\/a>.<\/p>\n<p>You will receive care from us in connection with your (upcoming) pregnancy, childbirth, and\/or postpartum period. You hereby grant permission for your medical data to be requested (digitally), processed, administered, stored, and, if necessary, shared with all healthcare providers involved in the pregnancy, both in writing and verbally, with the aim of improving the quality of care provided. <\/p>\n<p>This concerns data that is deemed necessary for the proper supervision of your pregnancy, childbirth, and postpartum period. We comply with the privacy requirements as described in the GDPR and WGBO (Medical Treatment Agreement Act) and other relevant legislation. This is explained in the Pregnant! brochure that will be given to you. You can withdraw your consent at any time in writing from the relevant healthcare provider(s)\/healthcare organization(s)<\/p>\n<p>You give the employees of Verloskundigenpraktijk de Kern permission to:<\/p>\n<ul>\n<li><strong>Requesting medical\/obstetric data<\/strong><\/li>\n<li><strong>Exchanging medical\/obstetric data (digitally)<\/strong> between relevant (obstetric) healthcare providers (including general practitioners, gynecologists, maternity care providers, pediatricians, Youth &#038; Family Centers, etc.)<\/li>\n<li><strong>Registration with national databases for quality and statistics <\/strong>(including Peridos*, Praeventis**, Perined***)<\/li>\n<li><strong>Passing on your email address to the CPZ for the PREM<\/strong> (the PREM is a nationally established short questionnaire about what is important to the new mother (the client) and useful for the healthcare provider. It asks about experiences with the care provided by each of the organizations (the midwifery practice, the hospital, and the maternity care organization) from which the client received care.<\/li>\n<li>Displaying the b<strong>irth announcement card <\/strong>you sent in the practice\u2019s waiting room<\/li>\n<\/ul>\n<p>You are aware of our Privacy Policy: <a href=\"https:\/\/dekernleiden.nl\/en\/privacy-statement\/\" target=\"_blank\" rel=\"noopener\">click here<\/a>.<\/p>\n<h3>* Peridos<\/h3>\n<p>Peridos is a national information system in which prenatal screening data is recorded. This digital file records data about the NIPT, 13-week and 20-week ultrasounds in order to improve and optimize the quality and process of screening. This data includes counseling about prenatal screening, performing the screening (NIPT), and performing the structural ultrasound examination (the ETSEO and the TTSEO). Healthcare data is also recorded, which provides insight into the quality of prenatal screening. This data includes personal and medical information. Participation in the PNS program is not possible without registration in Peridos. Data on pregnant women can be removed from Peridos after the screening. Pregnant women can submit this request for anonymization to their obstetric care provider.<br \/>More information at <a href=\"http:\/\/www.peridos.nl\" target=\"_blank\" rel=\"noopener\">www.peridos.nl.<\/a>       <\/p>\n<h3>**Praeventis<\/h3>\n<p>Praeventis is a national registration system in which the data from blood tests on pregnant women is recorded. This is to guarantee the quality of the blood tests and to monitor the process. The RIVM is responsible for this and ensures optimal security of the data. The data from the blood tests is also included in a national information system, the Sanquin Blood Supply Foundation. The Personal Data Protection Act applies to this registration. If you need blood in the future, the blood transfusion laboratory will be able to access your data.<br \/>Your baby\u2019s heel prick file will also be recorded in Praeventis. This file contains personal data and medical data. Participation in blood testing is not possible without registration, but after the test, pregnant women can object to their data being included in the digital database. Pregnant women can submit this request for anonymization to their obstetric care provider.<br \/>More information at <a href=\"http:\/\/www.pns.nl\" target=\"_blank\" rel=\"noopener\">www.pns.nl<\/a>.        <\/p>\n<h3>***Perinatale Registratie Nederland (PRN)<\/h3>\n<p>Perinatal Registration Netherlands (PRN) focuses on care surrounding childbirth. The aim is to provide insight into and improve the quality of care by collecting data on mothers and children throughout the entire process of pregnancy, birth, and postpartum. This data is used, for example, to conduct scientific research, provide insight into figures at the practice, regional, and national levels, and develop birth weight curves. Midwifery practices, hospitals, birth centers, and maternity care centers provide this data (securely). Personal data and medical data are processed in this registry. More information: <a href=\"http:\/\/www.perined.nl\" target=\"_blank\" rel=\"noopener\">www.perined.nl.<\/a>     <\/p>\n<p><em>Last update: 16-10-2025<\/em><\/p>\n<p>[\/et_pb_text][et_pb_code _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<noscript class=\"ninja-forms-noscript-message\">\n\tNotice: JavaScript is required for this content.<\/noscript>\n<div id=\"nf-form-4-cont\" class=\"nf-form-cont\" aria-live=\"polite\" aria-labelledby=\"nf-form-title-4\" aria-describedby=\"nf-form-errors-4\" role=\"form\">\n\n    <div class=\"nf-loading-spinner\"><\/div>\n\n<\/div>\n        <!-- That data is being printed as a workaround to page builders reordering the order of the scripts loaded-->\n        <script>var formDisplay=1;var nfForms=nfForms||[];var form=[];form.id='4';form.settings={\"ninjaForms\":\"Ninja Forms\",\"changeEmailErrorMsg\":\"Please enter a valid email address.\",\"changeDateErrorMsg\":\"Please enter a valid date!\",\"confirmFieldErrorMsg\":\"These fields must match!\",\"fieldNumberNumMinError\":\"Please enter a number that is not below the minimum.\",\"fieldNumberNumMaxError\":\"Please enter a number that is not above the maximum.\",\"fieldNumberIncrementBy\":\"Please increment by %s\",\"fieldTextareaRTEInsertLink\":\"Insert Link\",\"fieldTextareaRTEInsertMedia\":\"Insert Media\",\"fieldTextareaRTESelectAFile\":\"Select a file\",\"fieldsTermsAdd\":\"Add New\",\"fieldsTermsNewName\":\"New term name\",\"tableInsertRowAbove\":\"Insert Row Above\",\"tableInsertRowBelow\":\"Insert Row Below\",\"tableInsertColumnLeft\":\"Insert Column Left\",\"tableInsertColumnRight\":\"Insert Column Right\",\"tableDeleteRow\":\"Delete Row\",\"tableDeleteColumn\":\"Delete Column\",\"tableDeleteTable\":\"Delete Table\",\"tableLegacyNotice\":\"This content has tables in the old editor format. 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We adhere to the rules and laws of the GDPR, the general data protection regulation (AVG in Dutch). Without your consent to make (careful) use of your personal data, we cannot treat you at our midwifery practice. 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