Patient referral card (PDF)

Listen Up…
Need a walk-in clinic?
Hennepin County Public Health
• 525 Portland Ave S.—4th floor
Minneapolis • 612-543-5555
Room 111 • 555 Cedar Street
St. Paul • 651-266-1352
Bring this card with you!
Get the facts: www.health.state.mn.us/std
For more cards, contact the Minnesota Department of Health, STD/HIV
Section, 651-201-5414. Please contact us if you require
this document in another format, such as large print, Braille, or on cassette
tape. Printed on recycled paper. March 2007.
IC#141-1813
Listen Up…
Need a walk-in clinic?
Hennepin County Public Health
• 525 Portland Ave S.—4th floor
Minneapolis • 612-543-5555
Room 111 • 555 Cedar Street
St. Paul • 651-266-1352
Bring this card with you!
Get the facts: www.health.state.mn.us/std
For more cards, contact the Minnesota Department of Health, STD/HIV
Section, 651-201-5414. Please contact us if you require
this document in another format, such as large print, Braille, or on cassette
tape. Printed on recycled paper. March 2007.
IC#141-1813
Listen Up…
Listen Up…
Need a walk-in clinic?
Hennepin County Public Health
• 525 Portland Ave S.—4th floor
Minneapolis • 612-543-5555
Room 111 • 555 Cedar Street
St. Paul • 651-266-1352
Bring this card with you!
Get the facts: www.health.state.mn.us/std
For more cards, contact the Minnesota Department of Health, STD/HIV
Section, 651-201-5414. Please contact us if you require
this document in another format, such as large print, Braille, or on cassette
tape. Printed on recycled paper. March 2007.
IC#141-1813
Need a walk-in clinic?
Hennepin County Public Health
• 525 Portland Ave S.—4th floor
Minneapolis • 612-543-5555
Room 111 • 555 Cedar Street
St. Paul • 651-266-1352
Bring this card with you!
Get the facts: www.health.state.mn.us/std
For more cards, contact the Minnesota Department of Health, STD/HIV
Section, 651-201-5414. Please contact us if you require
this document in another format, such as large print, Braille, or on cassette
tape. Printed on recycled paper. March 2007.
IC#141-1813
You may have been exposed to an STD* if you’ve been given this card. Get checked today.
Provider, this person is a contact to a
patient diagnosed with:
You may have been exposed to an STD* if you’ve been given this card. Get checked today.
Provider, this person is a contact to a
patient diagnosed with:
_____________________________on _______________ (date).
_____________________________on _______________ (date).
________________________________________________
________________________________________________
Clinic
OPMR#
Clinic
OPMR#
*Sexually Transmitted Diseases can develop into serious
health complications if left untreated. Protect yourself and
see a doctor for testing and possible treatment immediately.
Bring this card to your doctor, school nurse, or walk-in clinic.
*Sexually Transmitted Diseases can develop into serious
health complications if left untreated. Protect yourself and
see a doctor for testing and possible treatment immediately.
Bring this card to your doctor, school nurse, or walk-in clinic.
You may have been exposed to an
STD* if you’ve been given this
card. Get checked today.
You may have been exposed to an
STD* if you’ve been given this
card. Get checked today.
Provider, this person is a contact to a
patient diagnosed with:
Provider, this person is a contact to a
patient diagnosed with:
_____________________________on _______________ (date).
_____________________________on _______________ (date).
________________________________________________
________________________________________________
Clinic
OPMR#
*Sexually Transmitted Diseases can develop into serious health complications if left untreated. Protect yourself and
see a doctor for testing and possible treatment immediately.
Bring this card to your doctor, school nurse, or walk-in clinic.
Clinic
OPMR#
*Sexually Transmitted Diseases can develop into serious
health complications if left untreated. Protect yourself and
see a doctor for testing and possible treatment immediately.
Bring this card to your doctor, school nurse, or walk-in clinic.