[Environmental medicine ambulatory and counseling centers in Germany--conceptional approaches, organizational structures, facility design and responsibilities].

: This paper presents the different concepts of realisation of the currently existing counselling institutions in Germany and ambulances for environmental medicine. It is based on the specific conceptual papers, reports of the ambulances and an inquiry with 20 counselling institutions and ambulances conducted especially for this purpose. From the noted special characteristics a typology of the "ambulance approach" is derived especially with regard to its place in larger institutions, theoretical concepts, specific contents, way of working, diagnostic as well as counselling requests, and usage frequencies. Basic differences exist between research and service projects and between the more general environmental medical services, the special wards in the framework of larger clinical departments (e.g. in dermatology, gynaecology and neurology) and the resources of the departments of occupational medicine. In addition, definite differences exist concerning the number of personnel and equipment, analytical and diagnostical possibilities, data assessment, data documentation, data processing and reporting. Current efforts of standardisation of documentation are presented as well as concepts for a better connection of environmental medical ambulances with physicians' private offices, hospitals, public administrations and laboratories.