Patient information

How to submit a declaration to our clinic:

One of the requirements of the NFZ (National Health Fund) contract for primary health care services held by NZOZ Poradnia Lekarza Rodzinnego Barbara Adamus-Sibik is that patients have completed documents on file. Thanks to this, you can be treated by a family doctor and nurses, and the related costs are covered from your contributions by the National Health Fund.

To ensure the best and most efficient service, it is best to complete these documents now, before you need our help – this will shorten the formalities before your first visit. First of all, a declaration should be completed.

Fill in the declarations:

The condition for free (NFZ-funded) use of primary health care is submitting a declaration choosing a POZ doctor (family doctor) and a POZ nurse (community family nurse and midwife). Please use the attached blank form:

Simply print it and fill it in. ATTENTION!!! Please remember to fill in all fields. In the health insurance card number field, enter the number of your insurance document. For a minor patient, the declaration may be completed by a parent or legal guardian. Please do not forget to sign in the marked places!

The completed declaration is best delivered in person or via a family member or carer, or sent by post to our clinic; at the moment you can also scan the signed declaration and send it by e-mail (bok@polskieporadniemedyczne.pl). Such a declaration can also be submitted through the IKP (Internet Patient Account).

After the complete set of documents has been checked, the patient will be entered on the patient list of NZOZ Poradnia Lekarza Rodzinnego Barbara Adamus-Sibik.

Please be sure to let us know if the patient has special entitlements (e.g. war invalid, honorary blood donor, a certificate of significant disability, etc.). Please have the document confirming the entitlement with you when submitting the declaration.

Dear Patients, since 1 January 2013 the electronic system for verifying the entitlements of beneficiaries (eWUŚ) has allowed you to verify your right to health care financed by the NFZ using your PESEL number. The information collected in the eWUŚ system is updated daily based on data received, among others, from ZUS and KRUS and shows the patient’s entitlement status on the day the check was made. Therefore you do not need to have your proof of health insurance with you.