Medizinische Hochschule Hannover : Request first presentation patient

Request for first presentation

Inquiry form for patients for initial presentation in the outpatient clinic of the Clinical Department of Pneumology and Infectious Diseases

Dear patient,

If possible, please use the following form to request a first presentation in an outpatient clinic of the Clinical Department of Pneumology and Infectious Diseases. Please note that we need your last physician's letter and the associated findings for evaluation. You must upload these directly here and thus help us to speed up the process of deciding on the presentation. If available: Please upload CT images here at the same time as your request. Further information can be found under outpatient clinics in the checklists for the appointment.

Request via e-mail

Alternatively, you can also send inquiries by e-mail. You can find these here under Outpatient clinics. Once we have received your complete documents, we will respond in writing and get back to you as soon as possible.

Tip: Create PDF documents with your cell phone

If you only have your physician's letters and findings in paper form, use free apps on your smartphone to quickly and easily create coherent PDF documents.

You can find these apps in the iOS App Store or in the Google Play Store by searching for "PDF Scanner", for example. Please note the corresponding data protection information.

Request for initial presentation

Data from your physician

Patient data

Name of: *

Institution / Facilities or Institutions:

E-mail address:

Telephone number: *

Fax number: *

Doctor's address:

Inquiry text:

Information obligations and Data Protection

I have taken note of the following information obligations, which fully inform me about the use of the data provided via the contact form: My personal data will be stored and processed on the server of the MHH data center in accordance with data protection regulations, in particular the GDPR. Employees of the Clinical Department of Pneumology and Infectiology at MHH have access to the data.

Purpose of data collection
My data will be used to contact me or to connect me to a specialist treatment at our Clinical Department.

Passing on the data
My personal data will not be passed on and is only accessible to those authorized to access it, i.e. the employees of the Clinical Department of Pneumology and Infectiology of the MHH, who need this data to fulfill contractual and legal obligations or to implement the legitimate interest of the MHH.

Storage
My data will be stored after collection by the MHH Clinical Department of Pneumology and Infectiology for as long as necessary to fulfill the purpose (contact, connection to the Clinical Department).

Revocation
I can unsubscribe from the connection to our Clinical Department at any time by sending an e-mail to pneumologie.ambulanz@mh-hannover.de. In the event of revocation, my data that I have provided via the contact form will be deleted.

Legal
In the data protection declaration linked under the form, I have taken note of the rights regarding the personal data concerning me in accordance with the GDPR.

Data Protection

Please read the data protection information carefully and find out how your data is handled and what your legal rights are.