Coordination request

Your NephroCare Holiday Dialysis Coordination Team is looking forward to assist you! Group requests are also welcome.

Email: internationalpatient@freseniusmedicalcare.com

Coordination Request Form

Please fill out the following fields below (* are mandatory) for a nonbinding coordination request. Our team will get back to you as soon as possible.

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Contact Information
Holiday Period
Destination

In order to determine availability for your initial, non-binding Holiday Dialysis coordination request all asked patient information is mandatory. Therefore, we kindly ask you to submit the information completely and correctly to the best of your knowledge.

After submitting your initial coordination request the provided information needs to be completed by submitting the full Holiday Dialysis coordination request form including a copy of blood serology test results. Any false information may lead to termination of given (pre-) confirmation.

Holiday Dialysis Coordination Patient Privacy Notice and Consent

What is this Holiday Dialysis Coordination Patient Privacy Notice about?
This Holiday Dialysis Coordination Patient Privacy Notice (“Notice”) explains how Fresenius Medical Care Deutschland GmbH, located at Else-Kröner-Straße 1 of Bad Homburg, Germany (also “Fresenius Medical Care” or “We”)  and Servicios Personas Y Salud , S.L.U. (part of Quironsalud Group), located at Calle Zurbarán, 28 of Madrid,Spain (also “SPS”) process your personal information, why and when. We are providing the service of Holiday Dialysis Coordination (“HDC”) for you. This Notice also describes your rights and how you can exercise them.

Who is the Data Controller for my information?
The data controller for your information used for HDC purposes is Fresenius Medical Care Deutschland GmbH.

What information do We collect, use, transfer and disclose, and why?
In the course of HDC activity, we will collect information about you. In the annex you will find more specific information regarding what personal information We process and the purposes for which We process it.

Your personal information is necessary for us to provide you with HDC. Your refusal to provide your personal information in whole or in part may make it impossible for Fresenius Medical Care and SPS to coordinate your holiday dialysis treatment.

Who has access to your personal information (including cross-border transfers)? We provide third parties or other entities of Fresenius Medical Care group with access to your personal information where this is necessary for the purposes listed in the annex. This is always on a need to know basis. For a list of the categories of third parties, please see the annex to this Notice.

These third parties are expected to protect the confidentiality and security of your personal information. Due to the global nature of our HDC service, We may transfer your personal information outside your home country including to countries that have a different data protection regime. If you are located in the European Economic Area (the "EEA") this may include countries outside of the EEA. In case of cross border transfer, the transfer of the personal information is based on EU standard contractual clauses that impose equivalent data protection obligations directly on the recipient, on the consent included in this Notice or on other legal mechanisms that may be required in your country.  A copy of the relevant mechanism can be provided for your review – see the contact us section for how to request this.

For how long do We keep your personal information?
After processing related to HDC, your personal information, including Medical Data, are stored for ten (10) years and subsequently erased. We do not keep the data you provide for HDC purposes de-identified for subsequent research and statistical purposes.

What are your rights?
You have the right to request a copy of your personal information, including health documentation and to request correction of any information that is incomplete or inaccurate. You may also have the right to receive the personal information which you provided to us in an electronic format so that you can transmit or request us to transmit this to another company.

You can object to the processing of your personal information in some circumstances (in particular, where We don’t have to process the information to meet a contractual or other legal requirement). You can ask us to erase your information in some circumstances. In certain circumstances, you also have the right to request that We restrict the processing of your personal data for certain purposes. These rights can be limited – for example where we need your personal information (i) to comply with the law or (ii) to protect your vital interests, or where providing your information would reveal personal data about another person. 
You can enforce any of the above rights by contacting us at contact details provided below.

How can I withdraw my consent?
If you give us consent to processing your personal information and Medical Data or transfer your personal information and Medical Data outside of the European Economic Area for HDC purposes, you can withdraw this consent at any time by contacting us at contact details provided below. Please note that withdrawal of consent does not affect the lawfulness of processing or transfer based on consent before its withdrawal.

Changes to this Notice
This Notice is effective as of 1st January 2021 and may be updated from time to time. We will notify you of material changes to our Notice by sending you an email or through other means in which We may also seek your consent

How to contact us?
For any concerns relating to data protection or in order to exercise your rights you may contact: Data Protection Officer Giovanni Brugugnone (mailto: giovanni.brugugnone@fmc-ag.com)

ANNEX
Types of Personal Information We Process:
Personal Details: Includes your name, date of birth, gender, home address, phone number(s), emergency contact details, race/ethnicity where this is relevant to your treatment.
Health insurance Data: Name of insurance provider, insurance specific patient codes and reference numbers, invoicing data, validity date.
Medical Data: Includes medical information received from your home clinic for subsequent transfer to holiday dialysis clinic, including:

  • Blood test results and the results of other medical tests
  • Information about your dialysis such as methods of access, prescription, temperature and time of treatment, medication administered and materials used (with LOT numbers), details of pressures, pumps, and any complications experienced
  • Blood tests and the results of other medical tests, information about drug therapies, transplant status, vaccination status, infective status and allergies, examinations, transfusions, hospitalisation, comorbidities and prior treatments
  • Information you provide about your health and well-being data

We obtain some of this information directly from you, some from the health professional who referred you and some from the home clinic or other healthcare institutions which are involved in your care and treatment.


The Purposes and Legal Bases for which We Process your Personal Information:

  • Where We have a contract to provide HDC, to fulfil this contract, or to take steps linked to the contract such as scheduling treatments or tracking the availability of dialysis stations at holiday dialysis clinics.
  • As required to conduct our business and pursue our legitimate interests, in particular managing complaints or claims.
  • With your consent, for the purpose of providing HDC services:
    • Fresenius Medical Care and SPS will process Medical Data received from you, from the health professional who referred you and from the home clinic or other healthcare institutions which are involved in your care and treatment.
    • Fresenius Medical Care & SPS will transfer your personal information and Medical Data to holiday dialysis units not belonging to Fresenius Medical Care network and located in countries that have a different data protection regime.

With whom do We share your personal information?
Third parties: To the extent permitted by applicable local provisions, with companies that provide products and services to Fresenius Medical Care, such as for invoicing and auditing purpose or for IT support. Other providers or companies that are involved in delivering or funding your care and treatment - including laboratories, transport companies, transplant centres, health insurance companies, dialysis clinics and units either belonging or not to Fresenius Medical Care network.
Medical Personnel: Such as clinical staff for treatment purposes and other medical personnel involved in your holiday dialysis treatment.
Fresenius Medical Care Personnel: Such as Country Medical Directors, members of HDC centers worldwide, and first level support for EuCliD for the purposes of medical treatment and providing recommendations to medical personnel.

Coordination of Holiday Dialysis Treatments - General Terms and Conditions

§ 1 Preamble
Fresenius Medical Care Deutschland GmbH (in the following “Fresenius Medical Care”) operates the international holiday dialysis coordination service in collaboration with the SERVICIOS, PERSONAS Y SALUD S.L.U. contact centre (in the following “SPS) and is responsible for the supporting coordination of dialysis treatments at holiday destinations (in the following “Holiday Dialysis”) of a patient (“Patient”). The Patient wishes to receive dialysis treatments at one or more holiday destinations and wishes to ask Fresenius Medical Care for coordination support and to handle requests regarding such Holiday Dialysis.

§ 2 Services of Fresenius Medical Care

  1. Fresenius Medical Care will support the coordination request for one or more dialysis treatments for the Patient at a center specialized in dialysis treatments identified by Fresenius Medical Care in accordance with the criteria indicated by the Patient.
  2. The coordination of Holiday Dialysis includes the evaluation of availability of potential dialysis centers at the requested holiday destination in accordance with the criteria indicated by the Patient in terms of location, period of time and times and frequency of dialysis treatments („Availability Check“). That means, Fresenius Medical Care coordinates the availability check request of the Patient in the name of the Patient at an available dialysis center selected by the Patient (in the following “Selected Dialysis Center”) and establishes contact between the Patient and the Selected Dialysis Center.
  3. For the sake of clarification, Fresenius Medical Care only provides support to establish the initial contact between the Patient and the Selected Dialysis Center. The final decision and confirmation whether a treatment can be performed during the requested time by Patient is solely at the discretion of the Selected Dialyses Center. In the event of any unforeseen changes (e.g. the first Selected Dialyses Center by the Patient cannot perform the treatment for medical reasons), Fresenius Medical Care will support the Patient by trying to establish a further contact with another potential Selected Dialyses Center. However, Fresenius Medical Care does not guarantee any positive outcome regarding the realization of the request of the Patient in any way.
  4. The actual treatments are exclusively handled by the Selected Dialysis Center which is fully and exclusively responsible for the treatment. Fresenius Medical Care is neither involved in the actual performance and legal compliance of such dialysis treatments nor in the booking or performance of the holiday trip.
  5. The actual treatments are exclusively handled by the Selected Dialysis Center which is fully and exclusively responsible for the treatment. Fresenius Medical Care is neither involved in the actual performance and legal compliance of such dialysis treatments nor in the booking or performance of the holiday trip.
  6. Fresenius Medical Care will provide the above mentioned Services under this Agreement free of charge.

§ 3 Responsibilities of the Patient

  1. The Patient shall provide all personal information required to successfully coordinate the requested Holiday Dialysis. In particular, the Patient shall provide information on his/her intended holiday trip (destination and period of time) and the requested dialysis times and frequency.
  2. Furthermore, the Patient shall ensure and hereby provides authorization that the physician treating him/her at his/her home dialysis center (in the following “home physician”) will provide the Selected Dialysis Center with the required medical and health information as listed in the attached “Holiday Dialysis Request” as soon as possible before the date of the scheduled beginning of the Holiday Dialysis. Fresenius Medical Care may assist the Patient by asking the home physician to complete the “Holiday Dialysis Request” and transferring the completed form to the Selected Dialysis Center or by asking the physician at the Selected Dialysis Center to access the data required via the electronic therapy information system “EuCliD 5”.
  3. The Patient shall return signed copies of this Agreement and the attached Consent Form as soon as possible before the date of the scheduled beginning of the Holiday Dialysis that is a prerequisite for Fresenius Medical Care to duly start coordinating the requested Holiday Dialysis.
  4. The Parties agree that a holiday dialysis center may deny treatment of a particular Patient at any time during the process supported by Fresenius Medical Care according to this Agreement, in particular, if a holiday dialysis center cannot provide the relevant resources required for a particular treatment. Fresenius Medical Care cannot be held responsible for any such rejection and/ or lack of resources of a holiday dialysis center.

§ 4 Term and Termination
This Agreement takes effect upon being duly signed by the Patient. This Agreement may be terminated by each Party at any time in written form.

§ 5 Liability
Fresenius Medical Care is only fully liable for damage caused to the Patient by an intentional or grossly negligent breach of duty by its employees, statutory representatives or auxiliary persons employed to perform duties under this Agreement. Where a claim for damages against Fresenius Medical Care is based on simple negligence on the part of Fresenius Medical Care (including the persons listed above), Fresenius Medical Care is liable only for

  • death, personal injury or damage to health or,
  • where the duty breached is an essential contractual obligation on compliance with which the Patient is usually and legitimately entitled to rely as a precondition for due performance of this Agreement, foreseeable damage typical of such contracts.

§ 6 Data Protection
The Patient notices that for the purpose of this Agreement it is necessary to provide and disclose personal data to Fresenius Medical Care and the physicians at the Selected Dialysis Center. The details of data processing operations in context with the coordination of Holiday Dialysis treatments are described in the attached Consent Form that is to be signed by the Patient.

§ 7 Miscellaneous

  1. This Agreement and the contractual relationship is governed by the laws of Germany. The statutory provisions to limit the choice of law and to apply mandatory provisions particularly of the state in which the Patient as a consumer has his habitual residence remain unaffected.
  2. Headlines in this Agreement are not relevant for the interpretation of the Agreement. Should provisions of this Agreement be or become invalid or unfeasible, the validity of the remaining provisions of this Agreement shall not be affected thereby. The parties are required to jointly replace the invalid or unfeasible provision with a valid provision approximating the invalid or unfeasible one as closely as possible. The same applies for any lacunae in this Agreement.
  3. There exist no ancillary verbal side-agreements to this Agreement. Any amendments of this Agreement must be in writing and must be signed by both parties. This does also apply to a change of this written form requirement. Unless legally required elsewhere, e-mail messages are not deemed to satisfy the written-form requirement.

 

Holiday Dialysis