Sign the tele-agreement – Support orthopedics

Name*

First Last

Email*

Your RIZIV number*

Your national identity number (needed to login with Itsme)*

Name of your practice or organisation*

Address of your practice or organisation*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your IBAN number for payments*

Company number (KBO)*

We want to show your practice or organisation info and address on our website and on a google map. Do you give your consent?*

Yes
No

To be allowed to attest the pseudocodes in the convention you need to digitally "agree" with the convention tele agreement convention tele agreement . Weekly we have to send a list to RIZIV with the physiotherapist who agreed with the convention and followed the e-learning course of moveUP.

Did you already complete the e-learning course?*

Yes
No

On a scale of 1 to 10: What did you think of the course?*

Can you give us some suggestions for improvement of the e-learning?

Digitally 'sign' the teleagreement mentioned above:*

I read the tele agreement and I agree and sign off for it

You can only sign the convention if you completed the e-learning course. Please come back once you finished the e-learning.

Some financial and other administration is linked to the convention.

Do you also want to do physical sessions for the patients that are digitally followed up by b.Clinic and live within your neighbourhood?*

Yes
No

F2 forfait can onnly be attested in combination with F1 and F3 forfaits. The F2 forfait is meant for moveUP. moveUP will send you an invoice at the end of the month for the F2 forfait. Click here for an overview of the pseudocodes

I declare I will attest F2 codes for moveUP when I make the attestation for F1 and F3/4 codes. I will invoice the patient, moveUP will send me an invoice for the F2 amounts I received.*

I read this and understood

Optional remark

Administration related to the convention