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consent*

I agree that Helios Klinkum Krefeld may forward the information and medical documents I have provided as part of my request to the relevant medical facilities of the Helios clinic, medical centers (so-called MVZ), polyclinics, the Center for Disease Prevention (HPC) to check the possibility and organization of treatment, as well as the fact that my discharge from the clinic can be requested and archived for documentation purposes. I agree that the international department of Helios, acting on behalf of Helios Klinikum Krefeld, may keep my statements and the final invoice for a period of five years after the end of my treatment at the respective medical facility of the Helios Group for the purpose of viewing my data, in case I reapply to Helios. I further agree that the Helios International Office may evaluate the physician’s letter (including diagnosis and treatment results) as well as the final invoice for quality management purposes and to determine economic key figures in anonymized form. This makes it more difficult to identify me personally, but it is still possible.

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