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)