Patient declaration Patient to doctor On the prescription form

My attending physician has informed me that, pursuant to § 31 para. 1 sentence 5 SGB V, I have the right to choose at which pharmacy I fill my prescriptions. Accordingly, my prescription is given to me in paper form. If I would like to receive the prescription as a digital prescription, the prescription can only be sent if it is ensured that the prescription can only be redeemed once. For this reason, it is not possible to send them directly to me, but it is possible to send them to a service that ensures one-time redemption.

• I would like my prescription to be given to me in paper form / sent to me by post.
• I would like my digital prescription to be sent to The Body Clinic, where I can then choose to have it sent to a cooperating pharmacy connected to the platform. To this end, I consent to my attending physician transmitting my prescription and thus my health data to The Body Clinic and release him from his duty of confidentiality in this respect.