For referrers

Requirement documents and participation declarations

Please select the network center at which the molecular pathology diagnostics are to be requested and the health insurance fund with which the patient is insured. If the desired health insurance company is not available as a selection, please select the last entry “Other health insurance companies”.

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Attention:
Please download both documents

Please note that in addition to the request form from the network center, you must also download and complete the declaration of participation from the cooperation health insurance fund.

By participating in the contract for special care in accordance with § 140a SGB V, the cooperation health insurance fund assumes the costs of molecular pathological diagnostics and second opinions at an nNGM center for its insured persons.

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Berlin Charité

Request form
pdf
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Declaration of participation
pdf
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Declaration of participation
pdf
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Declaration of participation
pdf
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Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Download
Declaration of participation
pdf
Stand: 13. September 2022