Consent Declaration

For the processing of personal data pursuant to GDPR

Note: The generated consent document is in German, as required by German law (GDPR / DSGVO). The form interface below is provided in English for your convenience.

What is this consent declaration?

To process your order and bill your care insurance fund, we process your personal data, including sensitive health data (care level, insurance number, and where applicable, diagnosis notes).

Legal basis: Art. 9(2)(a) GDPR (explicit consent for health data) and Art. 6(1)(b) GDPR (performance of contract)
You may revoke this consent at any time with future effect – contact details are provided at the bottom of this page.

Revoking your consent does not affect the lawfulness of processing carried out prior to the revocation. Ongoing supplies may no longer be billed to the care insurance fund after revocation.

Data we process

Personal master data

Name, address, date of birth

Insurance data

Health insurance fund, insurance number

Health data

Care level (Pflegegrad)

Order data

Products, quantities, delivery address

Purposes of data processing

Order processing and dispatch
Billing with the care insurance fund (§ 40 SGB XI)
Approval application with the care insurance fund
Customer service and communication
Statutory retention obligations (§ 147 AO, 10 years)

Fill in & print consent

Data stays on your device

Fill in the fields — the completed document will be prepared for review or can be printed. NO data is transmitted to us.

First name *

Last name *

Date of birth

Street and house number

Postal code

City

Name of care insurance fund

Insurance number

Confirmations (will appear in the document)

I consent to the processing of my health data (care level, insurance number) for order processing and billing with the care insurance fund.

I have read the privacy policy.

I am aware that I can revoke this consent at any time.

Your entries are processed exclusively locally in your browser. No data is transmitted to our servers (Art. 5(1)(c) GDPR).

Odenwald PflegeBox

Obere Marktstraße 1
64711 Erbach
E-Mail: info@odenwald-pflegebox.de
Telefon: 06062 9179446

Einwilligungserklärung

zur Verarbeitung personenbezogener Daten gemäß DSGVO

Ich, , geboren am ,
wohnhaft:

Versichert bei: , Versichertennr.:

willige hiermit ausdrücklich in die Verarbeitung meiner personenbezogenen Daten einschließlich meiner Gesundheitsdaten (Pflegegrad, Versichertennummer) durch Odenwald PflegeBox zur Abwicklung meiner Bestellung und zur Abrechnung mit meiner Pflegekasse gemäß § 40 SGB XI ein.

Rechtsgrundlage: Art. 9 Abs. 2 lit. a DSGVO, Art. 6 Abs. 1 lit. b DSGVO

Hinweis zum Widerrufsrecht:

Mir ist bekannt, dass ich diese Einwilligung jederzeit mit Wirkung für die Zukunft widerrufen kann bei:
Odenwald PflegeBox, Obere Marktstraße 1, 64711 Erbach
E-Mail: info@odenwald-pflegebox.de | Tel.: 06062 9179446

Ort, Datum

Unterschrift

Revoke consent

You may revoke this consent at any time informally and without giving reasons, with future effect. The revocation does not affect the lawfulness of processing carried out prior to revocation.

Odenwald PflegeBox

Obere Marktstraße 1, 64711 Erbach
E-mail: info@odenwald-pflegebox.de
Phone: 06062 9179446 (Mon–Fri, 09:00–17:00)

Revoke via e-mail Read privacy policy

Close menu