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Full name Required Date of birth Required Format: DD/MM/YYYY Home address (street, postcode, city) Required Statutory health insurance fund (Krankenkasse) Required Health insurance number (Krankenversichertennummer) Required 🔒 Stored encrypted; only used to generate your draft. First day of incapacity for work Required Date of the doctor's incapacity-for-work certificate (AU) — decisive for when the entitlement starts. Format: DD/MM/YYYY Diagnosis / main complaints Required ICD-10 code or plain text; stored encrypted and shared only with the health insurance fund. 🔒 Stored encrypted; only used to generate your draft. Treating doctor Required Last gross salary before incapacity (€/month) Required 🔒 Stored encrypted; only used to generate your draft. Employer Required

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Private Buronia help — not a government service. Krankenkasse (gesetzliche) ↗

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