Infusion Therapy (Vitamin C)

The infusion therapy is billed according to GOÄ (German Schedule of Fees for Physicians).

The creation of the living will is billed according to GOÄ (German Schedule of Fees for Physicians) and includes the following costs:

• Infusion therapy (vitamin C), costs: 85,70€ (incl. material)

For more information, see: Avismed – Infusion Therapy

The service is considered agreed upon and the costs are to be paid by you, regardless of whether your insurance reimburses them. You confirm this with your signature at the end of this form.

Invoice Assignment

For invoicing and billing, we work with our partner AvisCode GmbH.

If you have any questions about billing, please contact us: rechnung@avismed.de

Your data will only be passed on with your consent and in compliance with the GDPR and the medical confidentiality obligation in accordance with § 203 StGB, which also applies to all AvisCode employees.

Thank you for your trust
Your Avismed team

Please read the information on data protection according to Art. 13 and 14 GDPR (we will send this to you by e-mail if you agree at the end of this form).

I agree with the

• Disclosure of the personal data required for billing and enforcement of the fee claims (e.g. name, date of birth, address, treatment and examination data) to AvisCode GmbH. I am informed that AvisCode uses external technical service providers to process this data, who act exclusively on behalf of AvisCode GmbH and are contractually obliged to comply with the applicable data protection regulations in accordance with Art. 28 GDPR
• Commissioning AvisCode by my doctor to create, send and manage invoices and payment reminders in my name, including the use of an online portal to provide this information
• Disclosure of information required for invoicing from the patient file to AvisCode and – in the event of a dispute – to courts or legal advisors. I release my doctor and the employees of AvisCode from the obligation of confidentiality to this extent.
• the release of Avismed from the obligation of confidentiality towards the external partner should there be different opinions in the course of the claim

I am informed that my treatment is not dependent on consent to the processing operations described above. This consent also applies to claims arising from future treatments. This declaration is made voluntarily.
The consent can be revoked at any time with effect for the future. The revocation does not affect the legality of the processing that has taken place up to that point on the basis of this consent.
If the declaration is made as a legal guardian of a minor child, I assure that the other legal guardian also agrees to the above regulations.
I will receive a copy of this declaration of consent by e-mail if I agree to it at the end of the form.