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The doctor or dentist in Germany must note all measures and results in the medical records which may be important for any (future) treatment. The medical records should for instance include
The medical records hence serve to document further treatment, but is also used as evidence in case of malpractice.
If the doctor or dentist does not note a measure in the medical records, it can initially be presumed in any court proceedings that this measure was not carried out. The documentation in the medical records is therefore useful both to the doctor or dentist and to you.
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