Special Options Contract (eng, PDF)

Transcription

Special Options Contract (eng, PDF)
(Affix patient data label here)
If no label is available:
Name:
Forename:
Admission date:
Medical insurance:
Insurance status:
M
DoB:
Time:
F
R
The Regensburg University Hospital
and the above-named patient hereby agree a
Special Options Contract
on the provision of separately billable special options
in keeping with the the general contract conditions (AVB)
and the standard charge scale.
The following special options have been agreed (check as applicable):
The services of all doctors of the hospital involved in the treatment, if these doctors themselves (private
doctors) or the hospital are entitled to charge for their services separately, including the services of any outside doctors or medical facilities on whom they may call (private medical care). Charges follow the currently
valid version of the standard charging scale for doctors or dentists.
Treatment in a single room.
€ 40,00/day
Accommodation and full board for an accompanying person without medical necessity.
€ 45,00/day plus VAT
Should the private doctor be unavailable for unforeseen reasons, the patient agrees to be treated by his or her
regular substitute.
Department/Private doctor
Regular substitute
Specialist fields
Department of Anaesthesia
Prof. Dr. Bernhard Graf
PD Dr. Barbara Sinner
PD Dr. York Zausig
Cardio-thoracic surgery
Prof. Dr. Thomas Bein
Operative intensive care medicine
Dr. Christopher Prasser
Vascular surgery; trauma surgery
Dr. Dirk Lunz
Cardio-thoracic surgery; intensive care medicine
PD Dr. Thomas Metterlein
Head and neck
Dr. Jens Kramer
Anaesthesia outside operating room
Dr. Gabriel Roth
Oral and maxillofacial surgery
Dr. Martin Kieninger
Neurosurgical intensivemedicine
Dr. Christoph Lassen
Pain clinic
Dr. Michael Dittmar
Ophthalmology
Dr. Philipp Prahs
Cornea
Prof. Dr. Herbert Jägle
Strabismus; Neuro-ophthalmology; orbita; juvenile opthalmology
PD Dr. Isabel Oberacher-Velten
Glaukoma
Dr. Theresa Barth
Eye lids
PD Dr. Andreea Gamulescu
Retina
Prof. Dr. Stefan Fichtner-Feigl
Splanchnic and transplantation surgery
Dr. Sabine Kümmel
Department of Surgery; proctology
Department of Ophthalmology
Prof. Dr. Horst Helbig
Stand: Juli 2016/ SAP 9200261
Department of Surgery
Prof. Dr. Hans Schlitt
Department of Vascular Surgery
Prof. Dr. Piotr Kasprzak
PD Dr. Karin Pfister
Department of Dermatology
Prof. Dr. Mark Berneburg
Prof. Dr. Ulrich Hohenleutner
Prof. Dr. Sigrid Karrer
Wards
Dr. Teresa Jeaeger
Outpatients
Dr. Sebastian Haferkamp
Oncology
Department/Private doctor
Regular substitute
Specialist fields
Ear, Nose, and Throat Department
Prof. Dr. Jürgen Strutz
PD Dr. Pingling Kwok
Prof. Dr. Thomas Kühnel
Dr. Jose C. Pérez Álvarez
Dr. Hermann N. Hilber
Prof. Dr. Holger Gassner
Prof. Dr. Peter Kummer
Department of Cardio-thoracic Surgery
Prof. Dr. Christof Schmid
Prof. Dr. Michael Hilker
Dr. Reinhard Kobuch
Aortic surgery; valve surgery
Dr. Andreas Keyser
Pacemaker/ICD Implantation
Dr. Leopold Rupprecht
VAD programme
Prof. Dr. Stephan Hirt
Heart transplants
Department of Thoracic Surgery
Prof. Dr. Hans-Stefan Hofmann
Dr. Reiner Neu
Department of Internal Medicine I
Prof. Dr. Martina Müller-Schilling
Dr. Ina Zuber-Jerger
Oncology
Endoscopy
Dr. Tanja Bergmann
Endocrinology
Prof. Dr. Martin Fleck
Rheumatology
Dr. Gisela Wölfel
CIBD (chronic inflammatory bowel disease); ultrasonics
Dr. Stephan Schmid
Intensive-care medicine
PD Dr. Kilian Weigand
Hepatology
PD Dr. Michael Selgrad
Infectiology
Prof. Dr. Dierk Endemann
Cardiology
Prof. Dr. Christian Schulz
Pneumology
PD Dr. Thomas Müller
Intensive-care medicine
Prof. Dr. Marcus Fischer
Emergency reception
Dr. Ekrem Uecer
Rhythmology
Prof. Dr. Michael Arzt
Sleep laboratory
Department of Internal Medicine II
Prof. Dr. Lars S. Maier
Department of Nephrology
Prof. Dr. Bernhard Banas
Prof. Dr. Carsten Böger
PD Dr. Tobias Bergler
Dialysis and intensive-care medicine
Dr. Daniel Zecher
Nephrological ward
Dr. Yvonne Ehrl
Outpatients
Department of Psychosomatic Medicine
Prof. Dr. Thomas Loew
Dr. Alexandra Lange
Department of Internal Medicine III
Prof. Dr. Wolfgang Herr
Prof. Dr. Ernst Holler
Stem cell transplantation
Haematological intensive care
Dr. Simone Thomas
Hämatologiscal ward
Dr. Matthias Grube
Oncological ward
Dr. Joachim Hahn
Oncological systemic therapy
Dr. Martin Vogelhuber
Psychotherapy
Dr. Christina Hart
Psychosomatic primary care
Dr. Michael Rechenmacher
Palliative medicine
Department of Paediatrics and Juvenile Medicine
Prof. Dr. Michael Melter
Dr. Birgit Knoppke
Paediatrics;
hepatology
Dr. Jürgen Kunkel
Paediatric Intensive care and emergency medicine
Dr. Dirk Grothues
Paediatric sonography
Department of Paediatric Haematology, Oncology and Stem-cell Transplantation
Prof. Dr. Selim Corbacioglu
PD Dr. Jürgen Föll
Department of Cranio- and Maxillo-facial Surgery
Prof. Dr. Dr. Torsten E. Reichert
PD Dr. Dr. Ulrich Wahlmann
paediatric
gastroenterology and
Department/Private doctor
Department of Neurosurgery
Prof. Dr. Alexander Brawanski
Department of Neuropathology
Prof. Dr. Markus Riemenschneider
Department of Radiotherapy
Prof. Dr. Oliver Kölbl
Department of Nuclear Medicine
Prof. Dr. Dirk Hellwig
Regular substitute
Dr. Odo-Winfried Ullrich
Dr. Sylvia Bele
Dr. Christian Doenitz
Dr. Monika Friedrich
Dr. Max Lange
Dr. Karl-Michael Schebesch
Prof. Dr. Jürgen Schlaier
Specialist fields
Tumor and vascular surgery
Neurosurgical Intensive care medicine
Spinal surgery
Paediatric neurosurgery
Electrophysiology; neurology
Tumor and vascular surgery
Funktional neurosurgery; pain therapy
Dr. Saida Zoubaa
Dr. Fabian Pohl
Dr. Jirka Grosse
PD Dr. Jörg Marienhagen
MUDr. Karin Menhart
Department of Trauma Surgery
Prof. Dr. Michael Nerlich
Dr. Carsten Neumann
PD Dr. Michael Müller
Prof. Dr. Peter Angele
Dr. Christian Pfeifer
Dr. Antonio Ernstberger
PD Dr. Johannes Zellner
Dr. Paul Schmitz
Dr. Michaela Huber
Dr. Florian Baumann
Dr. Werner Krutsch
Department of Hand and Reconstructive Plastic Surgery
Prof. Dr. Dr. Lukas Prantl
PD Dr. Jürgen Dolderer
Department of Clinical Chemistry and Laboratory Medicine
Dr. Petra Lehn
PD Dr. Wulf Schneider
Dr. Susanne Heimerl
Department of Transfusion Medicine
Dr. Norbert Ahrens
Dr. Robert Offner
Department of Infectiology
Prof. Dr. Bernd Salzberger
Dr. Gabriele Birkenfeld
Department of Microbiology and Hygiene
Prof. Dr. Dr. André Gessner
Prof. Dr. Barbara Schmidt
PD Dr. Wulf Schneider
Department of Radiology
Prof. Dr. Christian Stroszczynski
Prof. Dr. Andreas Schreyer
Prof. Dr. Gerhard Schuierer
Prof. Dr. Okka Hamer
Prof. Dr. Ernst-Michael Jung
PD Dr. Peter Heiss
Prof. Dr. Dr. Walter Wohlgemuth
PD Dr. Philipp Wiggermann
PD Dr. Patrick Hoffstetter
Department of Operative Dentistry and Periodontology
Prof. Dr. Wolfgang Buchalla
Prof. Dr. Kerstin Galler
Department of Orthodontics
Prof. Dr. Dr. Peter Proff
Dr. Anita Castro Laza
Department of Prosthetic Dentistry
Prof. Dr. Gerhard Handel
Prof. Dr. Michael Behr
Conventional nuclear medicine (including
SPECT/CT, apart from thyroid); bone and joint
therapy
Thyroid diseases
PET/CT; SIRT therapy; Paediatric nuclearmedicine
Spinal surgery
Navigation and robotics
Knee surgery
Shoulder surgery
Foot surgery
Cartilage and joint surgery
Pelvic and hip surgery
Interdisziplinary emergency care
Paedriatic Traumatology
Sports Traumatology
Laboratory and transfusion medicine
Virology
Bacteriology
Neuroradiological diagnostics and intervention:
Neurosurgery; ENT; Ophthalmology; MCG (all
procedures),
CNS-diagnostics,
emergency
(CT/MRI/angiography and intervention)
Cardiopulmonary diagnostics (CT, MRI, CTbased interventions)
Ultrasonic diagnostics und gynaecological radiology; special procedures (all modalities)
Abdominal radiology and general radiology (all
procedures)
Vascular medicicne and interventional radiology
(all procedures); Centre for Vascular Anomalies
Surgical x-ray including interventional procedures
Musculoskeletal diagnostics (all procedures)
The patient hereby agrees to all data necessary for billing purposes being passed to an external billing
agency.
Notes:
1. The separately billable special options agreed between the hospital or, in the case optional medical
care, private doctors and the patient, will be provided within the limits of the available personnel
and material resources, in such a way that the general work of the hospital is not disturbed.
2. The hospital or, in the case optional medical care, private doctors can refuse special options to patients who have not paid the costs of a previous hospital treatment, or paid these after their due
date.
3. The hospital or the private doctors can temporarily suspend provision of special options without notice whenever and for as long as this is necessary to ensure the provision of general hospital care
to other patients; the patent can cancel the agreement at any time, the agreement terminating at
the end of the day following cancellation; either party can cancel the agreement without notice for
good cause.
4. The hospital and the private doctors can require appropriate advance payments or part payments.
5. Transfer of costs:
The costs of special options are not covered by German statutary health insurance policies
(gesetzliche Krankenversicherung). Patients receiving special options are direct-payers,
and obliged to cover the costs themselves. Patients are advised to ascertain in advance if
these costs are covered by a private medical ensurance, by an employer (Beihilfe) or by any
other agency.
6. In the case of separately billable care by private doctors, it is not possible to contract the care of
only one private doctor (§ 17 KHEntgG). An agreement about separately billable medical care extends to all the doctors of the hospital involved in the care of the patient who are are entitled to
charge separately for in-patient, out-patient, pre-admission or postdischarge treatment (§ 115a
SGB V), including services by doctors and medical institutions outside the hospital which are arranged by them. This applies also if the hospital itself charges for treatment by a private doctor.
7. Disclaimer of liability in case of separately billable care by private doctors:
In the case of separately billable care by private doctors, the hospital is contractually obliged only
to provide accommodation, meals and nursing services. Only those doctors entitled to charge for
their services separately are party to the special options contract. The hospital accepts no liablility
either in contract or in tort for mistakes by private doctors. The private doctor is personally responsible for providing the services to which he or she has agreed, and he or she alone is liable. This
applies also to mistakes made by auxiliaries (for example subordinate doctors or doctors consulted
for a second opinion) whom he or she may call upon. The hospital has liability for those medical
services for which it itself charges.
Date
Signature of Hospital Staff Member
Patient (in the case of minors: parent or guardian)
or representative with power of attorney
(name and address in block capitals)