T-RENA Teilnahme- und Leistungsnachweis (Gruppenleistungen / Einzelleistungen) – Formular der Deutschen Rentenversicherung Completed Form Examples and Samples
View detailed examples and downloadable samples of the T-RENA Teilnahme- und Leistungsnachweis (Form G0852) from the Deutsche Rentenversicherung. Learn how to correctly fill out the form for both group (Gruppenleistungen) and individual (Einzelleistungen) services, ensuring all patient, provider, and session details are accurate for a smooth process.
T-RENA Teilnahme- und Leistungsnachweis (Gruppenleistungen) Example
How this form was filled:
This example shows a completed T-RENA participation and performance record for group services. It includes the patient's personal and insurance details, the rehabilitation provider's information (including the IK number), and a record of all 26 completed training sessions, concluding with the signatures of both the participant and the provider.
Information used to fill out the document:
- Patient Name (Name der/des Versicherten): Erika Mustermann
- Date of Birth (Geburtsdatum): 15.05.1966
- Insurance Number (Versicherungsnummer): 12 150566 M 123
- Provider Name (Name des Anbieters): Reha-Zentrum Vitalis GmbH
- Provider ID (Institutionskennzeichen - IK): 260123456
- Provider Address (Anschrift des Anbieters): Musterstraße 10, 10115 Berlin
- Service Type (Leistungsart): Gruppenleistung (Gerätegestütztes Training)
- Program Start Date (Beginn der T-RENA): 20.11.2025
- Program End Date (Ende der T-RENA): 10.05.2026
- Total Sessions Completed (Anzahl der durchgeführten Termine): 26
- Reason for Termination (Grund der Beendigung): Reguläres Ende nach 26 Einheiten
- Participant Signature (Unterschrift Versicherte/r): Erika Mustermann
- Provider Signature (Stempel/Unterschrift des Anbieters): Klaus Schmidt, Leitender Physiotherapeut
- Signature Date (Datum): 10.05.2026
What this filled form sample shows:
- Correctly entered patient personal data and German Pension Insurance number (Versicherungsnummer).
- Accurate provider information including the official Institutional Identifier (IK-Nummer) required for billing.
- Complete documentation of the program duration and the total number of 26 completed group sessions.
- Proper signatures from both the participant and the provider representative to validate the completion of the program.
Form specifications and details:
| Form Name: | T-RENA Teilnahme- und Leistungsnachweis (Formular G0852) |
| Issuing Authority: | Deutsche Rentenversicherung Bund |
| Use Case: | Documenting the completion of a T-RENA post-rehabilitation program (group services) for submission to the German Pension Insurance. |
| Language: | German |
Created: February 19, 2026 11:56 PM
