1. Change to the agreement on the use of the blank form printing process for the production and printing of forms for statutory health care

from October 1st, 2014

The following changes are made in Chapter 2 of the agreement:

I. Numbers 2.11 and 2.11.7 change as follows:

2.11 Sample 11 / E: Report for the medical service (as of 1.2015)

2.11.7 Sample 11 / E (see appendix)

II. Numbers 2.17, 2.17.1 to 2.17.3 and 2.17.7 change as follows:

2.17 Model 17 / E: Medical certificate for the receipt of sick pay (as of 1.2015)

2.17.1 The form is to be created on A4 portrait security paper.

2.17.2 The form is provided with barcode. The specifications of the barcode can be found in the currently valid version of the "Technical Manual for Blank Form Printing".

2.17.3 Unoccupied

2.17.7 Sample 17 / E (see Appendix )

III. Numbers 2.25 and 2.25.8 change as follows:

2.25 Sample 25 / E: Suggestion of outpatient preventive care in recognized health resorts in accordance with Section 23 (2) SGB V (as of 1.2015)

2.25.8 Sample 25 / E (see appendix)

IV. The numbers 2.39, 2.39.7, 2.39.8 and 2.39.10 change as follows:

2.39 Sample 39 / E: Documentation form for cancer screening for women (as of 1.2015)

2.39 .7 Sample 39a / E (see attachment)

2.39.8 Sample 39b / E (see attachment)

2.39 .10 sample 39d / E (see appendix)

V. Numbers 2.50 and 2.50.7 change as follows:

2.50 sample 50 / E: Inquiry about the responsibility of another cash register (status: 1.2015)

2.50.7 sample 50.2 / E (see appendix)

VI. Numbers 2.51 and 2.51.7 change as follows:

2.51 sample 51 / E: Inquiry about the responsibility of another cost bearer (status: 1.2015)

2.51.7 sample 51.2 / E (see appendix)

VII. Numbers 2.52 and 2.52.7 change as follows:

2.52 sample 52 / E: Inquiry if the incapacity for work persists (as of 1.2015)

2.52.7 sample 52.2 / E (see appendix)

VIII. Numbers 2.53 and 2.53.7 change as follows:

2.53 sample 53 / E: Inquiry about the connection with incapacity for work (as of 1.2015)

2.53.7 sample 53.2 / E (see attachment)

This agreement comes into force on January 1st, 2015.

National Association of Statutory Health Insurance Physicians, K. d. ö. R., Berlin

GKV-Spitzenverband, K. d. ö. R., Berlin

Berlin, December 11, 2014

Appendix

2.11.7 Sample 11 / E

Original: DIN A5 portrait

2.17.7 Sample 17 / E

Original: A4 portrait

2.25.8 Sample 25 / E

Original: DIN A4 portrait

2.39.7 Sample 39a / E

Original: DIN A5 landscape

2.39.8 Sample 39b / E

2.39.10 Sample 39d / E

Original: A4 portrait

2.50.7 Sample 50.2 / E

Original: A4 portrait

2.51.7 Sample 51.2 / E

Original: A4 portrait

2.52.7 Sample 52.2 / E

Original: A4 portrait

2.53.7 Sample 53.3 / E

Original: DIN A4 high