Request to open a medical file
Dear patient
In addition to personal information, we need information about health conditions. And it is important for treatment. This information will be kept confidential according to the information confidentiality laws.
أمراض القلب :
أمراض القلب و الأوعية:
أمراض العظم :
أمراض الدم:
أمراض انتانية :
أورام / سرطانات:
أمراض عصبية:
أمراض أخرى :
معلومات إضافية:
أمور لنا :
Below I pledge
1. Notify any changes before the date of subsequent treatments
2. Commitment to appointments and cancel them in the appropriate time (at least 24 hours in advance). Otherwise, it is possible to pay the no-show compensation bill.
Ok to store information about me.
I agree to information regarding x-rays, medical reports, plaster examples, to the attending physician or informant by regular mail or encrypted e-mail.
I have read and understand the instructions regarding collecting personal information about me and agree to them (DSGVO)
