36. Modification of the agreement on forms for statutory health care

Announcements

from April 1, 1995

1. The following changes will be made to the agreement on forms for statutory health care:

I. The footnote in the table of contents for sample 17 is deleted.

II. Numbers 2.11, 2.17 and 2.39 change as follows:

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

The footnote contained in the heading to point 2.17 is deleted.

2.39 Model 39: Documentation form for cancer screening women (as of 1.2015)

2. The following changes will be made to the explanations of the form:

I. The following change is made in number 6 of the “General” section:

6. If the electronic health card is presented, the doctor automatically transfers the data to the forms for the statutory medical care using card terminal and in connection with his practice EDP. For house calls, the doctor fills out the personal details field manually if he does not have any appropriately prepared forms.

The following should be noted about the numerical information printed out via the electronic health card:

After the cash register name in the personal data field two-digit number is given. This includes clear assignment of the insured person's place of residence to the statutory health insurance association.

In the status field, the type of insured person, optionally the special group of persons and optionally the DMP indicator is printed. More detailed information on the use of the insured person's master data is given in the technical annex to Annex 4a BMV-Ä.

The personal details field also contains the date of issue and optionally the date on which the insurance cover ends. The latter is printed below the date of birth in the address field.

For more information on the use of the electronic health card in the doctor's practice and the replacement procedure if the card is not presented or for other reasons, see Appendix 4a BMV-Ä of the "Agreement on content and how to use the electronic health card ”.

II. Number 8 of the form explanations for sample 1 changes as follows:

8.

Announcements

from April 1, 1995

1. The following changes will be made to the agreement on forms for statutory health care:

I. The footnote in the table of contents for sample 17 is deleted.

II. Numbers 2.11, 2.17 and 2.39 change as follows:

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

The footnote contained in the heading to point 2.17 is deleted.

2.39 Model 39: Documentation form for cancer screening women (as of 1.2015)

2. The following changes will be made to the explanations of the form:

I. The following change is made in number 6 of the “General” section:

6. If the electronic health card is presented, the doctor automatically transfers the data to the forms for the statutory medical care using card terminal and in connection with his practice EDP. For house calls, the doctor fills out the personal details field manually if he does not have any appropriately prepared forms.

The following should be noted about the numerical information printed out via the electronic health card:

After the cash register name in the personal data field two-digit number is given. This includes clear assignment of the insured person's place of residence to the statutory health insurance association.

In the status field, the type of insured person, optionally the special group of persons and optionally the DMP indicator is printed. More detailed information on the use of the insured person's master data is given in the technical annex to Annex 4a BMV-Ä.

The personal details field also contains the date of issue and optionally the date on which the insurance cover ends. The latter is printed below the date of birth in the address field.

For more information on the use of the electronic health card in the doctor's practice and the replacement procedure if the card is not presented or for other reasons, see Appendix 4a BMV-Ä of the "Agreement on content and how to use the electronic health card ”.

II. Number 8 of the form explanations for sample 1 changes as follows:

8.The determination of the incapacity for work may neither be forwards nor backdated; rather, the day on which the incapacity for work was actually medically determined for the period of incapacity for work specified in the current certificate of incapacity is to be used. This date can also be the day on which another doctor (doctor on call or emergency service, transit doctor) has previously determined the incapacity for work instead of the contract doctor providing the signature.

III. Numbers 5, 8 and 11 of the form explanations for sample 5 change as follows:

5. The treatment as recognized psychotherapy must be marked by ticking the relevant field. In this case, the date of the notification of recognition from the health insurance company must also be entered.

8. The service field is used to indicate the services provided. The entries are to be made in the specified manner. After the date, the services of doctor-patient contact must be specified as fee schedule item (GOP) according to EBM or as further regionally permissible account number according to the specifications of the responsible KV. If the information on doctor-patient contact extends over more than one line, the date must not be repeated in the following lines. If, in exceptional cases, there are several doctor-patient contacts on the same day, the time must also be entered after the first service of each further doctor-patient contact.

A service must be justified if this is done by the EBM or the responsible KV prescribes. The reason must be put in brackets after the GOP concerned. When billing outpatient or attending medical operations in Section 31.2 EBM, the operation and procedure codes and, if applicable, the date of the first operation, the complications that occur including ICD-10 coding, the total cut-suture time and, in the case of simultaneous interventions, are the To put diagnoses for the main and secondary intervention in brackets after the GOP concerned. Deviating registration requirements of the competent KV remain unaffected.

If laboratory tests according to Chapter 32 of the EBM are carried out on the same body material, the tests must be entered under the date on which the last individual examination was carried out, provided that the body material was carried out on one day or was taken on two consecutive days and, if necessary, examined on several days.

If the service field is not sufficient for the notation of the services provided, the billing recommendations of the responsible KV must be observed. This applies accordingly to the diagnosis field.

11. The patient confirms in the designated place - above the field for the stamp of the contract doctor / therapist - with the date and signature that he is insured with the specified health insurance company.The determination of the incapacity for work may neither be forwards nor backdated; rather, the day on which the incapacity for work was actually medically determined for the period of incapacity for work specified in the current certificate of incapacity is to be used. This date can also be the day on which another doctor (doctor on call or emergency service, transit doctor) has previously determined the incapacity for work instead of the contract doctor providing the signature.

III. Numbers 5, 8 and 11 of the form explanations for sample 5 change as follows:

5. The treatment as recognized psychotherapy must be marked by ticking the relevant field. In this case, the date of the notification of recognition from the health insurance company must also be entered.

8. The service field is used to indicate the services provided. The entries are to be made in the specified manner. After the date, the services of doctor-patient contact must be specified as fee schedule item (GOP) according to EBM or as further regionally permissible account number according to the specifications of the responsible KV. If the information on doctor-patient contact extends over more than one line, the date must not be repeated in the following lines. If, in exceptional cases, there are several doctor-patient contacts on the same day, the time must also be entered after the first service of each further doctor-patient contact.

A service must be justified if this is done by the EBM or the responsible KV prescribes. The reason must be put in brackets after the GOP concerned. When billing outpatient or attending medical operations in Section 31.2 EBM, the operation and procedure codes and, if applicable, the date of the first operation, the complications that occur including ICD-10 coding, the total cut-suture time and, in the case of simultaneous interventions, are the To put diagnoses for the main and secondary intervention in brackets after the GOP concerned. Deviating registration requirements of the competent KV remain unaffected.

If laboratory tests according to Chapter 32 of the EBM are carried out on the same body material, the tests must be entered under the date on which the last individual examination was carried out, provided that the body material was carried out on one day or was taken on two consecutive days and, if necessary, examined on several days.

If the service field is not sufficient for the notation of the services provided, the billing recommendations of the responsible KV must be observed. This applies accordingly to the diagnosis field.

11. The patient confirms in the designated place - above the field for the stamp of the contract doctor / therapist - with the date and signature that he is insured with the specified health insurance company.

A signature from the patient is not required if the patient has legal representative (e.g. insured persons under the age of 15) or if he is unable to provide signature. The patient's signature is not required if the only services in the quarter are costs, reports or health insurance inquiries, services according to GOP 01430, 01435 and 01820 EBM and / or telephone consultations according to GOP 01214, 01216 and 01218 EBM in the case of treatment / p>

IV. The form explanations for sample 6 change as follows:

The referral slip is used to transfer the necessary diagnostic or therapeutic services to another contract doctor, one in accordance with Section 311, Paragraph 2, Clauses 1 and 2 of the Social Code V Approved facility, medical care center, authorized physician or an authorized medically managed institution. A referral slip must also be used if the contract doctor has an outpatient operation in the hospital, an outpatient treatment in the hospital in accordance with Section 116b SGB V (in the version valid until December 31, 2011) or an assignment to outpatient specialist care in accordance with Section 116b SGB V causes. Medical services provided as part of the program for the early detection of breast cancer through mammography screening do not require referral to sample 6.

A referral slip may only be issued if the referring contract doctor has received valid electronic Health card or proof of entitlement in accordance with Section 19 (2) BMV-Ä has been presented. Exceptions are permitted if, for example, B. the measures to be taken are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.

The doctor who acts on the referral is generally bound by the referral slip issued; He is not allowed to issue his own billing slip (sample 5).

The health insurances inform their insured that the doctor who is called upon to make referral must also present the referral slip in addition to the electronic health card.

To be completed by the referring contract doctor and to be observed by the doctor who acts on the referral:

1. The referring contract doctor must indicate whether the referral is for curative care , for prevention , for consulting doctor for attending medical treatment or as an assignment to one Treatment according to § 116b SGB V takes place.

2. The quarter in which the transfer was issued must be entered in the relevant field in the form "QJJ".

A signature from the patient is not required if the patient has legal representative (e.g. insured persons under the age of 15) or if he is unable to provide signature. The patient's signature is not required if the only services in the quarter are costs, reports or health insurance inquiries, services according to GOP 01430, 01435 and 01820 EBM and / or telephone consultations according to GOP 01214, 01216 and 01218 EBM in the case of treatment / p>

IV. The form explanations for sample 6 change as follows:

The referral slip is used to transfer the necessary diagnostic or therapeutic services to another contract doctor, one in accordance with Section 311, Paragraph 2, Clauses 1 and 2 of the Social Code V Approved facility, medical care center, authorized physician or an authorized medically managed institution. A referral slip must also be used if the contract doctor has an outpatient operation in the hospital, an outpatient treatment in the hospital in accordance with Section 116b SGB V (in the version valid until December 31, 2011) or an assignment to outpatient specialist care in accordance with Section 116b SGB V causes. Medical services provided as part of the program for the early detection of breast cancer through mammography screening do not require referral to sample 6.

A referral slip may only be issued if the referring contract doctor has received valid electronic Health card or proof of entitlement in accordance with Section 19 (2) BMV-Ä has been presented. Exceptions are permitted if, for example, B. the measures to be taken are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.

The doctor who acts on the referral is generally bound by the referral slip issued; He is not allowed to issue his own billing slip (sample 5).

The health insurances inform their insured that the doctor who is called upon to make referral must also present the referral slip in addition to the electronic health card.

To be completed by the referring contract doctor and to be observed by the doctor who acts on the referral:

1. The referring contract doctor must indicate whether the referral is for curative care , for prevention , for consulting doctor for attending medical treatment or as an assignment to one Treatment according to § 116b SGB V takes place.

2. The quarter in which the transfer was issued must be entered in the relevant field in the form "QJJ".

If the doctor who acts on the referral does not begin his treatment until the following quarter, the issued referral slip can be used, provided the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of eligibility.

3. For services according to Section 31.2 EBM, the date of the OP must be specified in the form "DDMMYY".

4. The gender of the patient must be indicated by marking the relevant field.

5. The referring contract doctor informs the doctor who acts on the referral by ticking the accident field if the treatment is necessary due to or as result of an accident so that the health insurance companies can claim costs from third parties. It means an unnecessary financial burden on the statutory health care provider if the accident field is not ticked in the event of an accident.

The form must not be used in the case of accidents at work, occupational diseases and school accidents. The settlement of the treatment of the accident or the consequences of the accident must be made with the accident insurance institution (on form A13 according to the doctor / accident insurance institution agreement). Accidents at school also include accidents involving children in kindergartens and students during their studies.

6. If the referring contract doctor has certified an incapacity for work, he informs the doctor acting on the referral by indicating the expected end of the incapacity for work in the field "AU bis" . This information is only required if the management of the treatment is to be passed on to the doctor responsible for further treatment.

7. In the line "Referral to ..." , with regard to the insured person's right to choose, no specific doctor needs to be specified, but only the relevant area description (e.g. ophthalmology). Exceptions to this rule are referrals to an authorized doctor or to an authorized, medically-managed institution for the implementation of certain examination or treatment methods (Section 24 (5) Federal Shell Agreement - Doctors). In these cases, the name and address of the authorized person can be given.

8. You must tick whether the transfer is made for execution of contract services , for consultation or for additional / further processing .

The type and scope of the orders are to be specifically determined (specification of the fee schedule item or the precise service description). The doctor executing the order may only perform the services specified under "Order".

If the doctor who acts on the referral does not begin his treatment until the following quarter, the issued referral slip can be used, provided the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of eligibility.

3. For services according to Section 31.2 EBM, the date of the OP must be specified in the form "DDMMYY".

4. The gender of the patient must be indicated by marking the relevant field.

5. The referring contract doctor informs the doctor who acts on the referral by ticking the accident field if the treatment is necessary due to or as result of an accident so that the health insurance companies can claim costs from third parties. It means an unnecessary financial burden on the statutory health care provider if the accident field is not ticked in the event of an accident.

The form must not be used in the case of accidents at work, occupational diseases and school accidents. The settlement of the treatment of the accident or the consequences of the accident must be made with the accident insurance institution (on form A13 according to the doctor / accident insurance institution agreement). Accidents at school also include accidents involving children in kindergartens and students during their studies.

6. If the referring contract doctor has certified an incapacity for work, he informs the doctor acting on the referral by indicating the expected end of the incapacity for work in the field "AU bis" . This information is only required if the management of the treatment is to be passed on to the doctor responsible for further treatment.

7. In the line "Referral to ..." , with regard to the insured person's right to choose, no specific doctor needs to be specified, but only the relevant area description (e.g. ophthalmology). Exceptions to this rule are referrals to an authorized doctor or to an authorized, medically-managed institution for the implementation of certain examination or treatment methods (Section 24 (5) Federal Shell Agreement - Doctors). In these cases, the name and address of the authorized person can be given.

8. You must tick whether the transfer is made for execution of contract services , for consultation or for additional / further processing .

The type and scope of the orders are to be specifically determined (specification of the fee schedule item or the precise service description). The doctor executing the order may only perform the services specified under "Order".An extension of the order in terms of type or scope requires the consent of the contract doctor who placed the order; it must be noted on the form.

The referral for the consultant examination initiates diagnostic services, the type and scope of which is decided by the performing doctor. Enter the reason for the investigation. The performing doctor is free to choose his diagnostic steps. These measures should be completed within reasonable period and the referring doctor should be informed of the result as soon as possible. Therapeutic measures are not billable.

9. The referral for co-treatment is made to accompany or supplement diagnostic or therapeutic measures. In the event of further treatment, the entire diagnostic and therapeutic work is transferred to another doctor. The field "Co-treatment / further treatment" must also be crossed for referrals to carry out outpatient operations.

10. In the outpatient specialist medical care (ASV), there is no referral requirement between the members of the core team. The specialists to be consulted provide their services as ASV entitled persons according to the respective scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in place 30 in the status field of the personal data field.

11. In the case of patients with limited entitlement to benefits in accordance with Section 16 (3a) SGB V , the referring contract doctor must tick the appropriate box to inform the doctor who acts on the referral about the limited entitlement to benefits.

12. Under "Diagnosis / suspected diagnosis", "Findings / Medication" or "Order" , the referring contract doctor has to provide the relevant information in order to enable the doctor who acts on the referral to To give advice on how to act and to avoid unnecessary costs through multiple examinations. For this reason, the contract doctor who is also treating / continuing treatment should be informed of the findings and / or treatment measures collected so far.

To be observed by the doctor who acts on the referral:

13. The doctor performing contract service is entitled to have parts of this contract that he cannot perform himself performed by another doctor as contract service (referral).An extension of the order in terms of type or scope requires the consent of the contract doctor who placed the order; it must be noted on the form.

The referral for the consultant examination initiates diagnostic services, the type and scope of which is decided by the performing doctor. Enter the reason for the investigation. The performing doctor is free to choose his diagnostic steps. These measures should be completed within reasonable period and the referring doctor should be informed of the result as soon as possible. Therapeutic measures are not billable.

9. The referral for co-treatment is made to accompany or supplement diagnostic or therapeutic measures. In the event of further treatment, the entire diagnostic and therapeutic work is transferred to another doctor. The field "Co-treatment / further treatment" must also be crossed for referrals to carry out outpatient operations.

10. In the outpatient specialist medical care (ASV), there is no referral requirement between the members of the core team. The specialists to be consulted provide their services as ASV entitled persons according to the respective scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in place 30 in the status field of the personal data field.

11. In the case of patients with limited entitlement to benefits in accordance with Section 16 (3a) SGB V , the referring contract doctor must tick the appropriate box to inform the doctor who acts on the referral about the limited entitlement to benefits.

12. Under "Diagnosis / suspected diagnosis", "Findings / Medication" or "Order" , the referring contract doctor has to provide the relevant information in order to enable the doctor who acts on the referral to To give advice on how to act and to avoid unnecessary costs through multiple examinations. For this reason, the contract doctor who is also treating / continuing treatment should be informed of the findings and / or treatment measures collected so far.

To be observed by the doctor who acts on the referral:

13. The doctor performing contract service is entitled to have parts of this contract that he cannot perform himself performed by another doctor as contract service (referral).If it is not possible for the doctor who has acted on referral to carry out consultant examination without calling on another doctor, the doctor who carries out the consultant examination can have individual services performed by another doctor as commissioned services.

14. If the doctor, who has acted on referral, treats an accident that only occurred during his treatment or that only became known during his treatment, he also ticks the accident field.

V. The form explanations for sample 10 change as follows:

For the transfer for the performance of the services of Chapter 32 EBM and for the corresponding medical laboratory services of Section 1.7 EBM, transfers for the performance of services according to the fee schedule items 11310 to 11322 of Section 11.3 as well as Section 11.4 EBM to another contract doctor, an institution approved according to Section 311, Paragraph 2, Clauses 1 and 2 SGB V, medical care center, an authorized doctor or an authorized, medically managed institution is sample 10, not to use sample 6.

A referral slip for laboratory tests as an order service may only be issued if the referring contract doctor has been presented with valid electronic health card in the relevant quarter. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.

The referral slip for laboratory tests is divided into two parts. The upper part of the form is used for identification. The lower part is the order part. Both parts must be completed by the referring contract doctor.

To be completed by the referring contract doctor and observed by the doctor who acts on the referral:

1. The referring contract doctor must indicate whether the order is in the context of curative care , prevention , conception regulation / sterilization / termination of pregnancy or in the case of medical treatment .

2. The referring contract doctor must indicate if the treatment is necessary due to or as result of an accident so that the health insurance companies can claim costs from third parties. It means an unnecessary financial burden on the statutory health care provider if the accident field is not ticked in the event of an accident.

3.If it is not possible for the doctor who has acted on referral to carry out consultant examination without calling on another doctor, the doctor who carries out the consultant examination can have individual services performed by another doctor as commissioned services.

14. If the doctor, who has acted on referral, treats an accident that only occurred during his treatment or that only became known during his treatment, he also ticks the accident field.

V. The form explanations for sample 10 change as follows:

For the transfer for the performance of the services of Chapter 32 EBM and for the corresponding medical laboratory services of Section 1.7 EBM, transfers for the performance of services according to the fee schedule items 11310 to 11322 of Section 11.3 as well as Section 11.4 EBM to another contract doctor, an institution approved according to Section 311, Paragraph 2, Clauses 1 and 2 SGB V, medical care center, an authorized doctor or an authorized, medically managed institution is sample 10, not to use sample 6.

A referral slip for laboratory tests as an order service may only be issued if the referring contract doctor has been presented with valid electronic health card in the relevant quarter. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.

The referral slip for laboratory tests is divided into two parts. The upper part of the form is used for identification. The lower part is the order part. Both parts must be completed by the referring contract doctor.

To be completed by the referring contract doctor and observed by the doctor who acts on the referral:

1. The referring contract doctor must indicate whether the order is in the context of curative care , prevention , conception regulation / sterilization / termination of pregnancy or in the case of medical treatment .

2. The referring contract doctor must indicate if the treatment is necessary due to or as result of an accident so that the health insurance companies can claim costs from third parties. It means an unnecessary financial burden on the statutory health care provider if the accident field is not ticked in the event of an accident.

3.If the requesting contract doctor uses the procedure for printing blank forms, two-dimensional barcode is printed which contains all the information on the form and which can be scanned into the practice management system by the doctor who is working on the order. In addition, the bordered field "Order number of the laboratory" can optionally be used by the doctor acting on the order for their own purposes.

4. If the prerequisites for an exceptional indication are met, the referring contract doctor gives the relevant identification number (32005 - 32023) in the corresponding field.

5. The quarter of the issue of the transfer is to be entered in the form "QJJ" in the relevant field.

If the doctor acting on behalf of the patient does not begin his treatment until the following quarter, the referral slip can be issued can be used if the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of eligibility.

6. The gender of the patient must be indicated by entering "W" or "M" in the relevant field.

7. If direct or indirect evidence of pathogens is commissioned as part of check-up for known infection, the field "Check-up of known infection" must be ticked. The facts must also be explained in the free text field "Findings / Medication". Diseases that require notification can be found in Section 7 of the Infection Protection Act.

8. In the outpatient specialist medical care (ASV), there is no referral requirement between the members of the core team. The specialists to be consulted provide their services as ASV entitled persons according to the respective scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in place 30 in the status field of the personal data field.

9. If the insured person submits sample 85 (proof of entitlement when the entitlement is suspended in accordance with Section 16 (3a) SGB V), the referring doctor only needs to make referrals in the context of acute illnesses and pain, as well as pregnancy and maternity. The referring contract doctor indicates this by ticking the field "limited entitlement to benefits according to § 16 paragraph 3a SGB V" .

10.If the requesting contract doctor uses the procedure for printing blank forms, two-dimensional barcode is printed which contains all the information on the form and which can be scanned into the practice management system by the doctor who is working on the order. In addition, the bordered field "Order number of the laboratory" can optionally be used by the doctor acting on the order for their own purposes.

4. If the prerequisites for an exceptional indication are met, the referring contract doctor gives the relevant identification number (32005 - 32023) in the corresponding field.

5. The quarter of the issue of the transfer is to be entered in the form "QJJ" in the relevant field.

If the doctor acting on behalf of the patient does not begin his treatment until the following quarter, the referral slip can be issued can be used if the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of eligibility.

6. The gender of the patient must be indicated by entering "W" or "M" in the relevant field.

7. If direct or indirect evidence of pathogens is commissioned as part of check-up for known infection, the field "Check-up of known infection" must be ticked. The facts must also be explained in the free text field "Findings / Medication". Diseases that require notification can be found in Section 7 of the Infection Protection Act.

8. In the outpatient specialist medical care (ASV), there is no referral requirement between the members of the core team. The specialists to be consulted provide their services as ASV entitled persons according to the respective scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in place 30 in the status field of the personal data field.

9. If the insured person submits sample 85 (proof of entitlement when the entitlement is suspended in accordance with Section 16 (3a) SGB V), the referring doctor only needs to make referrals in the context of acute illnesses and pain, as well as pregnancy and maternity. The referring contract doctor indicates this by ticking the field "limited entitlement to benefits according to § 16 paragraph 3a SGB V" .

10.The acceptance date must be entered in the corresponding field (form TTMMJJ) by the sender if necessary for the diagnosis of the results in accordance with the guidelines of the German Medical Association for quality assurance of medical laboratory examinations.

11. The acceptance time must be entered in the appropriate field (form hhmm) by the sender if necessary for the evaluation of the results in accordance with the guidelines of the German Medical Association for quality assurance of medical laboratory examinations.

12. In the event of an urgent transmission of findings, the referring contract doctor can mark them as such and note the telephone or fax number to which the findings are also to be sent.

13. After naming the diagnosis / suspected diagnosis, the referring contract doctor must specify the type and scope of the contract services in the order field as an ICD code, the findings or the medication (information on the fee schedule item or the precise service description). The doctor performing the contract may only perform the examinations specified in the order field. An extension of the order in terms of type or scope requires the consent of the referring contract doctor; it is to be noted on the form.

In addition, the diagnosis or suspected diagnosis and important findings / medications should also be communicated to the doctor acting on behalf of the order.

The doctor, who acts on bank transfer, please note:

14. The doctor performing contract service is entitled to have parts of this contract that he cannot perform himself performed by another doctor as contract service (referral). In this case, he must also issue referral slip according to sample 10 and provide the relevant information, in particular to take over the information of the first initiator and to indicate his doctor and establishment number in the relevant bold-framed field.

15. The framed field "order number of the laboratory" can optionally be used by the doctor working on the order for their own purposes.

VI. The form explanations for sample 10A change as follows:

A request form for laboratory examinations in laboratory communities may only be issued if the requesting contract doctor has been presented with valid electronic health card in the quarter in question. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the requesting contract doctor knows the health insurance provider beyond doubt.

The request form for laboratory tests in laboratory communities is divided into two parts. The upper part of the form is used for identification.The acceptance date must be entered in the corresponding field (form TTMMJJ) by the sender if necessary for the diagnosis of the results in accordance with the guidelines of the German Medical Association for quality assurance of medical laboratory examinations.

11. The acceptance time must be entered in the appropriate field (form hhmm) by the sender if necessary for the evaluation of the results in accordance with the guidelines of the German Medical Association for quality assurance of medical laboratory examinations.

12. In the event of an urgent transmission of findings, the referring contract doctor can mark them as such and note the telephone or fax number to which the findings are also to be sent.

13. After naming the diagnosis / suspected diagnosis, the referring contract doctor must specify the type and scope of the contract services in the order field as an ICD code, the findings or the medication (information on the fee schedule item or the precise service description). The doctor performing the contract may only perform the examinations specified in the order field. An extension of the order in terms of type or scope requires the consent of the referring contract doctor; it is to be noted on the form.

In addition, the diagnosis or suspected diagnosis and important findings / medications should also be communicated to the doctor acting on behalf of the order.

The doctor, who acts on bank transfer, please note:

14. The doctor performing contract service is entitled to have parts of this contract that he cannot perform himself performed by another doctor as contract service (referral). In this case, he must also issue referral slip according to sample 10 and provide the relevant information, in particular to take over the information of the first initiator and to indicate his doctor and establishment number in the relevant bold-framed field.

15. The framed field "order number of the laboratory" can optionally be used by the doctor working on the order for their own purposes.

VI. The form explanations for sample 10A change as follows:

A request form for laboratory examinations in laboratory communities may only be issued if the requesting contract doctor has been presented with valid electronic health card in the quarter in question. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the requesting contract doctor knows the health insurance provider beyond doubt.

The request form for laboratory tests in laboratory communities is divided into two parts. The upper part of the form is used for identification.The lower part is the order part. Both parts are to be completed by the requesting doctor.

To be completed by the requesting contract doctor and to be observed by the laboratory community that works on the order:

1. The contracting doctor making the request must indicate whether the order is made within the framework of curative care, prevention or medical treatment .

3. If the requesting contract doctor uses laser printer, two-dimensional barcode 417 can be printed, which contains all information of the form and can be automatically evaluated in the laboratory community.

4. If the prerequisites for an exceptional indication are met, the requesting contract doctor enters the relevant identification number (32005 - 32023) in the corresponding field.

5. The gender of the patient must be indicated by marking the relevant field.

6. The acceptance date must be entered in the corresponding field in the form DDMMYY.

7. The acceptance time must be entered in the corresponding field in the form hhmm.

8. The diagnosis or suspected diagnosis and important findings / medications are to be communicated to the laboratory community working on the order in the diagnosis field.

9. The contracting doctor making the request has to manually note the order services with lines in the order field .

10. In the order field, the services of the general laboratory not included in the order field are available under Other.

11. The laboratory community performing the contract may only carry out the tests that are specified in the contract field. Number 8 of the form explanations for sample 16 changes as follows:

8. If regulation is issued to the detriment of an accident insurance institution, the day of the accident and the accident operation (if applicable kindergarten, school, university) must be specified in the fields provided in addition to the name of the responsible accident insurance institution. Furthermore, the checkbox "Work accident" must be marked. If the patient field is labeled using an electronic health card, it is essential to delete the cost unit identification.

VIII. The footnote in the heading to sample 17 is deleted.

IX.The lower part is the order part. Both parts are to be completed by the requesting doctor.

To be completed by the requesting contract doctor and to be observed by the laboratory community that works on the order:

1. The contracting doctor making the request must indicate whether the order is made within the framework of curative care, prevention or medical treatment .

3. If the requesting contract doctor uses laser printer, two-dimensional barcode 417 can be printed, which contains all information of the form and can be automatically evaluated in the laboratory community.

4. If the prerequisites for an exceptional indication are met, the requesting contract doctor enters the relevant identification number (32005 - 32023) in the corresponding field.

5. The gender of the patient must be indicated by marking the relevant field.

6. The acceptance date must be entered in the corresponding field in the form DDMMYY.

7. The acceptance time must be entered in the corresponding field in the form hhmm.

8. The diagnosis or suspected diagnosis and important findings / medications are to be communicated to the laboratory community working on the order in the diagnosis field.

9. The contracting doctor making the request has to manually note the order services with lines in the order field .

10. In the order field, the services of the general laboratory not included in the order field are available under Other.

11. The laboratory community performing the contract may only carry out the tests that are specified in the contract field. Number 8 of the form explanations for sample 16 changes as follows:

8. If regulation is issued to the detriment of an accident insurance institution, the day of the accident and the accident operation (if applicable kindergarten, school, university) must be specified in the fields provided in addition to the name of the responsible accident insurance institution. Furthermore, the checkbox "Work accident" must be marked. If the patient field is labeled using an electronic health card, it is essential to delete the cost unit identification.

VIII. The footnote in the heading to sample 17 is deleted.

IX.The form explanations for sample 39 change as follows:

The referral slip for the preventive cytological examination (sample 39a), which corresponds to the two-part documentation form for cancer early detection examinations for women (samples 39b and 39d [sample 39c is unoccupied] ), replaces the referral slip (sample 6) in the case of referrals for preventive cytological examination and saves the referring physician from having to write on the personal data field twice as result of the carbon copy procedure makes billing easier. It is not necessary for the cytologist to state the date of receipt and the examination number on this form. However, if this helps to simplify the internal practice organization, they can be copied on receipt on the following set of forms.

The documentation form (samples 39b to 39d) is filled in on the basis of the cancer screening guidelines of the Federal Joint Committee.

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

Old sample 39 may no longer be used.

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

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

Berlin, December 11, 2014