Admission Agreement - Goldenes Kreuz

Your wellbeing is close to our heart
Patient label
Dear patient,
Admission Agreement
ME/UK/201107
We are pleased to cordially welcome you as a patient at the Goldenes Kreuz Privatklinik and
would like to make your stay in our hospital as pleasant as possible according to our motto
“Your wellbeing is our concern”.
We kindly ask you to carefully read this document, which contains a summary of the most
important information on your admission to and treatment in our hospital.
The Goldenes Kreuz Privatklinik is organised as a non-profit open hospital. We have granted
your trusted doctor, as an affiliated physician who is entitled to practise independently, the right
to treat his patients making use of the infrastructure of our private clinic. For this purpose we
place our premises, equipment and staff at the affiliated doctor’s disposal. Your doctor is fully
responsible for all medical measures taken during your outpatient or day-clinic treatment or
during your in-patient stay at our hospital. He also instructs the nursing staff at his disposal and
may also call in other consultant doctors on his own responsibility.
Please note that your medical treatment is therefore based exclusively on the treatment
contract concluded between you and your doctor. This also applies if the affiliated doctor
treating you is an employee of our institution and / or is one of our private clinic’s head
physicians.
As an affiliated physician your doctor is fully liable for all aspects of the medical treatment
which is provided by himself and by any other experts and staff involved under your doctor’s
responsibility. The Goldenes Kreuz Privatklinik does not assume in any case any liability for
damage caused by wrong medical treatment, not even if the treatment was provided by a doctor
who is employed by our hospital.
In addition to the treatment contract you have concluded with your trusted affiliated doctor you
also conclude a hospital admission agreement with the Goldenes Kreuz Privatklinik by
signing the present document, which covers all aspects associated with your stay at the private
clinic such as accommodation, food, medical care, attendance and nursing provided by our
hospital. Moreover we guarantee that our nursing staff has the necessary qualifications and
that the infrastructure of our hospital and its organisation work efficiently.
Goldenes Kreuz Privatklinik BetriebsGmbH Tel. +43 (1) 40 111 - 0, Fax - 9505 Erste Bank, Kto.Nr. 012-01816
Lazarettgasse 16-18, 1090 Vienna, Austria verwaltung@goldenes-kreuz.at BLZ 20111
www.goldenes-kreuz.at FN 251327z, HG Wien

Your wellbeing is close to our heart.
In case that for factual or legal reasons my supplementary private health insurance denies full
or partial coverage of the costs for the provided services, I expressly agree to directly pay the
costs incurred for my in-patient treatment, less the share covered by my social insurance, to the
Goldenes Kreuz Privatklinik. If the social insurance institution denies covering the costs for my
stay in the Goldenes Kreuz Privatklinik, I agree to also pay these costs myself to the private
clinic.
I have been informed that the provisions of the Austrian private health insurances on differential
cost guarantee only apply to twin rooms and have taken notice of the fact that for the use of a
single room on my own request and without a separate private single-room insurance contract
an additional daily fee will be charged in accordance with the applicable fees.
I herewith authorise the Goldenes Kreuz Privatklinik to demand on my behalf from my
supplementary private health insurance the direct payment of the costs to be covered and
settled according to the contractual provisions and the agreed fees. As soon as the private clinic
has received payment from my private health insurance their claim for payment expires
provided that this payment is sufficient to entirely cover the billed costs for my hospital stay (setoff).
If my social insurance covers parts of the costs incurred for my treatment in the special hospital
class, I agree with and authorize the private clinic to instruct the social insurance institution to
directly transfer the recoverable amount owed for my treatment to my private health insurance.
If the social insurance does not transfer the full recoverable amount I furthermore assume the
obligation towards my supplementary private health insurance to pay this amount to my
supplementary private health insurance.
b) Day-clinic stays
I have been informed that the social insurance institutions and the supplementary private health
insurances cover the costs for a day-clinic stay only if it replaces an otherwise necessary inpatient
stay. In case the insurance companies deny coverage because a minor out-patient
treatment is considered as not “requiring in-patient treatment”, I agree that the costs will be
billed to me for payment by myself. The medical treatment itself is covered by the
supplementary private health insurance only if my supplementary private health insurance
includes a contract for day-clinic treatment.
c) I have NO supplementary private health insurance
I confirm that I was informed about the fees of the Goldenes Kreuz Privatklinik before my
admission and expressly declare to pay to the private clinic the costs incurred for my hospital
stay, less the share covered by my social insurance. In case that the social insurance institution
does not cover the costs for my stay, I will also bear the portion of costs which would otherwise
be covered by the social insurance and will pay these costs directly to the private clinic.
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