DE1972946U - FORM SET FOR HEALTH INSURANCE OD. DGL. - Google Patents

Description

PA WM12-8,9.66 I.

» _N Munich, September 8, 1966

OIPL-ING. tf ti I IN CR _{P 696}

NCHEN 5, ERHARDTSTRASSE8

F. SOENNECKEN company, Bonn, Kirschallee 1-

Form set for health insurance companies ο do the like.

The invention relates to a set of forms, which is particularly suitable for use by health insurance companies, Statutory health insurance physicians and their billing offices are determined ο The forms used for this are in place essentially from a health insurance certificate, a prescription form, a benefit card, a Illness history card and, if necessary, a referral slip. Any desired

Duplicates of these forms or, if applicable

also additional ,, similar forms as

Supplementing the set of forms cannot be ruled out.

Filling out all of these forms has been relatively cumbersome and time-consuming. The health insurance certificate is usually issued by the relevant health insurance company., if necessary also by a company health insurance fund or by the company itself all necessary information and data of the person concerned, in particular name, profession, address, Date of birth, membership number, etc. must be entered for the first time. Then comes the Sick certificate to the doctor, who in turn provides the same information and data on his disease history card must write. For the third time, this information and data must be borrowed from the cash register Settlement office must be entered, and for the fourth time the doctor must provide this information and write data again on the recipe form. If necessary, the same process must be carried out at Filling out a transfer slip must be repeated. Certain information such as the one prescribed

Medicines or treatments must at least be on some forms, such as in particular on the Written down several times on the prescription form or on the disease history card. Certain other information, such as the medical diagnosis in particular, must also be entered on most of the forms but not on all of them, especially not on the prescription form. All these Entries are associated with multiple work, apart from the fact that when the information is transferred spelling mistakes can be made from one form to another.

The invention is based on the object to provide a set of forms that all necessary Forms designed appropriately and appropriately to one another and combined in such a way that all or at least most of the duplication and duplication of work can be avoided.

According to the invention, this object is fundamentally achieved solved by the fact that all forms of the form set have the same width, but at least partially different heights that they have in the sentence compound with their side and head margins

aligned one above the other and that the sheets of carbon paper inserted between the individual forms or the like. the same width as the! sum Forms, but sometimes have different effective heights or colored areas or gaps.

This ensures that the health insurance company already writes out the health insurance certificate or the operation of most of the doctor's written work can be done at the same time. on the other hand the doctor is able to present the diagnosis made by him when entering it on the health insurance certificate at the same time on the performance card, on the disease progression card and, if necessary, on other forms or copy duplicates without the diagnosis getting on the prescription form. It can also be achieved that the prescription orders are transferred to the Disease history card is saved »In addition, the later billing becomes significant in this way simplified and saved a lot of work in all areas. Mistakes or mistakes made so far could arise when copying or separately transferring information to another form, will be switched off for sure.

A particularly useful and advanced feature of the invention is in the form set also seen in the fact that the prescription form is instead of the usual portrait format up to now A landscape format is given, which in terms of its width matches the other forms of the The set of forms. The prescription area used for writing down the ordinances etc. is expediently provided with transverse lines, and the prescription form receives according to an advantageous Embodiment of the invention in the neighboring chaft of the left side edge a perforated line Or folding or the like. So that a stop is formed that a copy on the disease history card conveniently made possible. The prescriptions, medicines, etc. then appear next to each other on the disease history card and save a special SÜi transfer work.

According to a further advantageous embodiment the invention can include at least one of the forms, in general the disease history card, about twice the height of the other forms and at the same time in the middle with a Folding, a perforation or the like. be provided

which allows this form to be bent or folded in such a way that a collection pocket is formed which, for example, can be used by the doctor to record receipts, certificates, attestations, etc.

In the practical implementation of the set of forms according to the invention sgärtoifrart-sg all Forms and preferably also the associated sheets of carbon paper on their upper transverse edges so connected that each form without breaking the cohesion of the rest Forms of the sentence is separable from the latter. This can be done with the help of appropriate head strips happen that are related to the actual forms, e.g. through perforation lines.

In the drawing, the invention is based on a set of forms for health insurance companies, doctors and For example, medical billing offices are illustrated. Show it

Fig. 1 a health insurance certificate,

2 shows a prescription form,

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Fig. 5 shows a service card for the medical accounting office,

Pig. 4 a duplicate of the service card or a transfer slip,

Fig. 5 is a disease history map for the Doctor, and

6 shows a complete set of forms,

in which the individual, stacked forms and sheets of carbon paper are shown broken off in steps on one side.

Sickness certificate 1 has a landscape format that is larger than its height, e.g. in DIN A5 landscape format. A number of areas are divided by longitudinal and transverse lines on the health insurance certificate provided with the necessary forms, namely those from the health insurance company or the company Columns to be filled in, which are also written down on the underlying forms should, essentially in the upper part of the form. So this part of the form takes particular

the personal details of the statutory health insurance patient such as name and address and date of birth, as well as certain calendar dates, the membership number of the insured person etc. All of this information should also be entered on the other forms.

The prescription form 2 has the same width as the health insurance certificate 1, but in general only a lesser height than this. In the top or header of recipe form 2 are the Labeling areas and rubrics as previously provided for the health insurance certificate.

The benefit card 3 expediently has the same format as the health insurance certificate. It contains in its upper part, again, the same lettering areas and forms as the health insurance certificate and the prescription form. The same applies, of course, to Form 4, which be a duplicate of the service card as a check for the doctor or, for example, a referral slip can.

The disease history card intended for the doctor 5 again has the same width as that

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Forms 1, 2, 3 and 4, but a larger one, useful twice as high as forms 1, 3 and 4. Accordingly, the disease history map 5 can be designed in DIN A4 portrait format. Also the course of the disease skarte 5 has the same labeling areas, forms and in its upper head part Headings like the other forms.

Between the individual forms 1 to 5 lying on top of one another in the set according to FIG. 6 are in a known manner means for copying the labels on the top Form can be made. Between the health insurance certificate 1 and the prescription form 2 there is e.g. a sheet of carbon paper 6 which is substantially the same width as these forms. In the drawing the sheets of carbon paper are protruding on the right side of the page under the individual forms has been drawn for clarity. In some circumstances, however, it could actually be Sheets of carbon paper are used, which protrude but not colored on this side Edge to make it easier to remove these sheets.

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Between the prescription form and the performance card 3 there is a carbon paper sheet 7, which in turn has essentially the same width as all forms, but has a slightly greater height than the carbon paper sheet 6, or. extends downward from the upper transverse edge lower than the sheet of carbon paper 6. Correspondingly sized sheets of carbon paper 8 and 9 are located between the forms 5 and ² J or 4 and 5.

The different heights of the carbon paper sheets β on the one hand and 7, 8, 9 on the other hand have the purpose of certain entries made on the health insurance certificate only apply to some of the other forms to have it copied. In the present case, it is the entry in the weeBntliehen the medical diagnosis, which is made on a special labeling field 10. This labeling field 10 is located below the upper part of the form or form head, which in the above the general information and data to be written down on all forms records. This inscription field 10 is thus outside the effective area of the carbon paper sheet 6. The diagnostic information, which is on the

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Sick note 1 are entered, so do not appear in the set of forms on the prescription form 2, which therefore does not have any special labeling field 10, but only on the other forms J, 4 and 5, over which the carbon paper sheets 7, 8 and 9 are located as a result of their greater height also extend over the labeling field 10 for the diagnosis entries. Instead, a sheet of carbon paper 6 with a corresponding recess or with a corresponding non-colored area could optionally also be used.

The prescription form 2 expediently has a folded or perforated or otherwise pronounced stop line 11 at a certain distance from its left longitudinal edge and parallel to it , which facilitates later copying of the prescription information on the disease history card 5.

All forms 1 to 5 preferably wad all carbon sheets 6 to 9 have an upper, narrow head strip 12 'in the block composite of the form set these headliners are stuck together and ensuring the cohesion of the form set. However

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are the forms with their headers 12 or the like through perforation lines. connected., so that each form can be separated from the set of forms, without the cohesion of the rest Forms will be lost as a result. However, it is also sufficient, if necessary, to simply fill in forms 1 to hold together by head strips 12 in the set and insert the carbon paper sheets 6 to 9 loosely., as indicated in the exemplary embodiment of the drawing.

One of the forms, preferably the large-format form 'ö serving as a disease history card, is of medium height with a fold

13 or with a correspondingly acting perforation line or embossed, "which a" fold over or bending over this card, so that a collection pocket is formed, which is mainly in the The doctor's registry or card index can advantageously be used to store any loose documents, Certificates or the like. to be stored collectively.

At least some forms, in particular prescription form 2, have transverse lines

14 to make labeling easier.

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This means that the prescription information can also be copied at the same time, e.g. on the disease history card 5 can be simplified.

It is also appropriate to use all forms with specific, highlighted identification areas for receiving forms or the like. which later, for example, facilitate the sorting work for the billing of the relevant health insurance company or other classifications. Thus, according to the exemplary embodiment, delimited, matching identification areas 15 , 16 are provided in the upper left and right corners of all forms. In these areas, for example, the code of the health insurance company concerned or the code of the status or gender of the insured person can appear.

Finally, it is useful to give each or some of the forms different colors or to mark them with different colors at least in some places. This will E.g. when the doctor bills later for the Kk medical billing office the sorting of the health insurance certificates and the service cards according to different member groups, i.e. for

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Men * women, pensioners, compulsorily insured persons, voluntarily Insured etc. much easier »

Otherwise, the invention is not limited to that described above and in the Drawing illustrated embodiment, but it includes all variants within the scope of the essentials Invention feature.

Protection claims

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Claims (8)

Protection claims t 1. Set of forms for health insurance companies, statutory health insurance physicians and their billing offices, consisting of a health insurance certificate, Prescription form, benefit card, illness history card and, if necessary, referral slip Or the like., characterized in that all forms (1, 2, 3j ^ j 5 «. ·.) have the same width, but at least partially have different heights that L, they in the sentence compound with their side and head fringes They are aligned one above the other, and that the sheets of carbon paper (6, Y, 8, 9 ·· ..) inserted between the individual forms have the same width as the forms, but sometimes have different effective heights or colored areas or recesses. 2. Form set according to claim 1, characterized in that at least two forms (1, j5, ² O have the same height, while at least one form (2) has a smaller height and at least one form (5) has a greater height than the same height Has forms (1, 3, 4). 3. Set of forms according to claim 1 or 2, characterized in that that at least two sheets of carbon paper (7 * 8.9) - 16 - .9.67 have the same height or color area, while at least one carbon paper sheet (6) has a smaller height or color area than the carbon paper sheets (7, 8, 9), 4. Form set according to claim J _9, characterized in that all carbon paper sheets (6, "J ₉ 8 _S 9) or their colored areas over the upper surface part of the form set (1, 2. ₃ J ₉ K ₉ 5) extend * for at least two sheets of carbon paper (7 * 8, 9) or their colored areas have larger dimensions. 5 «Form set according to one or more of Claims 1 to 4 _5, characterized in that the form (2) of lower height has a folded, perforated or otherwise pronounced stop line (11) at a certain distance from its left longitudinal edge and parallel to it. having. - 17 - 6. Form set according to one or more of claims 1 to 5, characterized in that all forms (1, 2, 3j ^ i 5) and optionally also the carbon paper sheets (6, ¹ J, 8, 9) at their upper transverse edges in such a way with each other are connected ₅ that each form can be separated from the set of sentences without impairing the cohesion of the other forms. 7 · form set according to claim 6, characterized in that the _forms} (1, 2, -5, 4, 5) by means of head bars (12) connected to each other with which they sindj example related by a perforation in each case. 8. Form set according to one or more of claims 1 to 7, characterized in that at least one form (5) * which is about twice the height of the other forms, in the middle with a fold (15) or a corresponding perforation or embossing is provided, which enables the form sheet to be folded into the shape of a collection bag. - 18 - RA.536 088 * 18.9.6 Set of forms according to one or more of Claims 1 to 8, characterized in that the forms (1, 2 ₃ J) ₃ k _$ 5) have at least partially different colors or are identified in different colors. P. SOENNEGKEN represented by (Edmund F. also) Patent attorney $ - tr »!». * TMs »Unfcjrfcxje '% ^ t ^ ss ^^ k wu Sohufzonsp ?.)« β fite nMti stacjerefchte: §5 «wsfcfo» in the Qi 'Oo. OtS legal Satfeö'ung tier A ^ wc-ichwo is not O Titikaü.h I iiinef 3in ^ aäaikiß w * i! Feii. .% «< Request will be bwsi from ouch Fo to the Qbliehen Praass JÄuiwiM · n