Declaration of Consent

for the collection/transmission of patient data according to §73 para. 1b SGB V

• I hereby consent that the practice Dr. med. Pohl / Dr. med. Vogt may request, store and, if necessary, transmit the treatment data and findings required for my treatment from my family doctor and other doctors or service providers for the purpose of documentation and further medical services.
• That requests for findings and transmissions of findings may be carried out by post, telephone and electronically via specially secured connections (e.g. KV-Safenet, telematics infrastructure).
• That data may be passed on to the Association of Statutory Health Insurance Physicians, health insurance companies, the Medical Service of the Health Insurance Companies or the Health Department in strict compliance with medical confidentiality, medical documentation requirements and legal disclosure obligations.

I am aware that I can revoke this declaration in whole or in part for the future at any time.

Note: Further information on data protection can be found on display in the waiting room.