Überweisungsschein

Hi everyone, I booked an appointment through Doctolib for Magenspielung because I suffered from Stomachache for a long time. During the appointment they asked me for Überweisungsschein from my Hausarzt which I overlooked to ask for. They told me to submit it later. But the problem is: My Hausarzt was not willing to give me an Überweisungsschein because I didn’t report my Stomachache to her earlier. I told her that I have had this problem for a long time and then she gave the following Überweisungsschein. Can anyone tell what to expect and do next to solve this issue? Will this Überweisungsschein work to cover the costs for Magenspielung?

Thanks in advance