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Cardinal Station Newburg Center for Primary Care
215 Central Avenue, Suite 100 1941 Bishop Lane, Suite 900 215 Central Avenue, Suite 205
Louisville, KY 40208 Louisville, KY 40218 Louisville, Ky 40208
I:\FCM\Phyllis Harris\Forms\New Patient Pkg Components
UofL Department of Family & Geriatric Medicine
Dear New Patient,
Welcome to your University of Louisville Physicians Family practice! We
are offering patient-centered medical care and are enthusiastic about our
relationships with our patients. In order to better serve your needs, we are
enclosing several forms and ask that you completely fill each form out.
The first sheet will help us learn more about you; please completely fill out this
form about your family history. The next sheet is titled, "Authorization for the
use and/or Disclosure of Protected Health Information", and you will need to
completely fill that out for our doctors to treat you to the best of their ability; it
gives us permission to review your medical records from your previous primary
medical facilities.
Following, please completely fill out the Registration, Social Services & Consent
Form. Next, you will find our Privacy Notice, followed by an acknowledgement that
you have received and understand our Privacy Policies. Finally, the last form is the
Office Acknowledgements and Policies form. Please read carefully and sign
your name at the bottom of the letter.
Please make sure to bring all of these forms with you to your first office visit.
Do not mail them back to the office. Also, please remember to always
bring your picture ID, current insurance cards and your co-payment. If your
health insurance requires you to select a primary care doctor please do so prior to
your office visit. Please bring in any and all medication you take, in their
original bottles, to your appointment.
If the patient is under 18 years of age he or she must be accompanied by an
adult and will need to bring a copy of their current immunization certificate.
Please arrive 15 minutes ahead of your scheduled appointment time so that if
you have questions about these forms or we need more information, we can
address it all prior to your appointment.
We look forward to seeing you!
University of Louisville Physicians
UofL Family and Geriatric Medicine

DÉCLARATION MONDIALE SUR LA SANTÉ Adoptée par la communauté mondiale de la santé lors de la cinquante et unième Assemblée mondiale de la santé, en mai 1998 I Nous, États Membres de l'Organisation mondiale de la Santé (OMS), réaffirmons notre attachement au principe énoncé dans la Constitution de l'Organisation selon lequel la possession du meilleur état de santé qu'il est capable d'atteindre constitue l'un des droits fondamentaux de tout être humain ; nous affirmons par là la dignité et la valeur de chaque personne, ainsi que l'égalité des droits et des devoirs et la responsabilité de tous dans le domaine de la santé. II Nous reconnaissons que l'amélioration de la santé et du bien-être des peuples est le but ultime du développement économique et social. Nous sommes attachés aux valeurs morales d'équité, de solidarité et de justice sociale, et à la prise en compte des spécificités de chaque sexe dans nos stratégies. Nous me ttons l'accent sur l'importance de la réduction des inégalités sociales et économiques pour améliorer la santé de l'ensemble de la population. Il est par conséquent impératif d'accorder la plus haute attention à ceux qui sont les plus démunis, qui souffrent d'une mauvaise santé, ne bénéficient pas de services de santé adéquats ou sont victimes de la pauvreté. Nous réaffirmons notre volonté de promouvoir la santé en agissant sur ses principaux déterminants et ses conditions de base. Nous reconnaissons que, pour faire évoluer la situation sanitaire mondiale, nous devons donner effet à la « politique de la Santé pour tous pour le XXIe siècle » par la mise en œuvre de politiques et de stratégies régionales et nationales appropriées1 . III Nous nous réengageons à renforcer, adapter et réformer, selon le cas, nos systèmes de santé, y compris les fonctions et services essentiels de santé publique, pour assurer un accès universel à des services de santé fondés sur des données scientifiques, de bonne qualité et dans des limites de coût abordables et qui puissent être durablement assurés à l'avenir. Nous entendons rendre accessibles les éléments essentiels des soins de santé primaires tels qu'ils sont définis dans la Déclaration d'Alma-Ata2 et développés dans la nouvelle politique. Nous continuerons à mettre en place des systèmes de santé adaptés à l'état de santé actuel et futur, à la situation socioéconomique et aux besoins des populations, des communautés et des pays concernés par des actions publiques et privées et des investissements judicieux.

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