Intercultural mediation, useful information for foreign nationals

Intercultural Mediation aims at facilitating foreign nationals in accessing healthcare facilities and services. It consists of a network of interpreters and mediators of different ethnicities, who serve as listening and support partners in the diagnostic and treatment process.
Various facilities of the healthcare system are provided with information desks specific for intercultural mediation. An on-call mediation service is also available throughout the day for both inpatients (upon request of the facility concerned) and outpatients (upon request of healthcare professionals).
Intercultural Mediators are also in charge of translating clinical documentation, when necessary, and of translating and disseminating information material for foreign nationals.
The healthcare facilities located along the coastal area of Romagna are provided with an interpreting service.
To receive information relevant to their healthcare assistance, foreign nationals can contact one of the permanent Intercultural Mediation information desks.
In case of hospitalization, healthcare professionals can activate the Intercultural Mediation service directly. Useful information Italian, Arabic, French, Chinese, and English.

Healthcare for foreign nationals

The Regional Health Service guarantees healthcare to foreign nationals registered with the Italian National Health Service. It also guarantees the provision of certain healthcare services to immigrants without residence permit, i.e., urgent (e.g., in Emergency Departments) or otherwise essential care for outpatients and inpatients in need of support for illnesses or injuries, pregnancy and maternity protection, child health protection, vaccinations, international prophylaxis measures, prophylaxis, diagnosis and treatment of infectious diseases, public services for drug addiction (Sert), and mental health services.
The registration with the National Health Service is free of charge. To register you need to go to the front desk (Sportello Unico) of your healthcare district (Azienda Usl) with your ID document, residence permit (or document proving that you are awaiting its issuance or renewal), and self-declaration of residence. Upon registration, you will be issued a health insurance card, which will be valid for the same period as your residence permit.
Foreign nationals who are provisionally living in Italy (Stranieri Temporaneamente Presenti – STP) and do not comply with entry and stay regulations are issued a special card with limited validity (6 months); this card is renewable until the procedure for the issuance of a residence permit is completed.
The health insurance card and the provisional STP card are personal documents (i.e., they can only be used for the person in whose name they were issued) and are necessary to access healthcare services (e.g., medical examinations, blood tests, other scheduled examinations).
Furthermore, the healthcare facilities offer services dedicated to foreign nationals specifically, such as the family counseling center (Consultorio familiare) and the service for immigrant women and their children (Spazio per le donne immigrate e loro bambini), where intercultural professionals support foreign women, with or without residence permit, in accessing healthcare services and relating with healthcare professionals.

Registering with the National Health Service (SSN)

To access the healthcare services covered by the Italian National Health Service (Servizio Sanitario Nazionale – SSN), you need to register with your local healthcare provider (AUSL).

The registration procedure and the required documents vary based on your category:
● Italian citizens residing in Italy and newborns residing in Italy
● EU-citizens registered with the Municipal Registry Office in Italy
● Homeless people (e.g., people working in traveling carnivals, wanderers constantly on the move for work reasons)
● Non-EU citizens
● Adopted or in pre-adoption foster care foreign minors

Upon registration with the SSN, you choose and register with a general practitioner (Medico di famiglia – MMG) or a pediatrician (Pediatra di famiglia – PLS) and receive a document certifying the registration with both the SSN and the GP.
Registering with a GP and canceling the registration
Your registration with the SSN is proven by your health insurance card (Tessera sanitaria); those who are entitled to healthcare assistance will receive such card at home from the Italian Revenue Agency (Agenzia delle Entrate).
Tax code and health insurance card in Emilia-Romagna

Furthermore, you can provisionally register with the SSN at the AUSL of the district where you temporarily live (if different than your Municipality of residence). The provisional registration is admitted based on one of the following reasons:
● Medical reasons
● Work reasons
● Study reasons
● Family reasons
● Mandatory stay or provisional release
● Unemployment

Your temporary stay in this Municipality must last longer than three months and the registration can be valid from three months minimum to one year maximum; afterwards, you can submit a request to renew it. The Agenzia delle Entrate will send your new health insurance card to your permanent address of residence, even if located in a different Region.

Registration with the Italian National Health Service: receiving the health insurance card

The registration with the National Health Service (SSN) is available for Italian citizens residing in Italy, newborns residing in Italy, EU-citizens residing in Italy, homeless people, non-EU citizens holding a valid residence permit.
The registration with the SSN is proven by the health insurance card (Tessera sanitaria), that the Italian Revenue Agency (Agenzia delle Entrate) sends to the home address of those entitled to medical assistance.
The card features the personal data and the tax code of the registered person.
The card must be shown to receive any service of the National Health Service and to receive medical assistance in other EU Countries.
For more information on your health insurance card, please, call the toll-free phone number of the Agenzia delle Entrate (+39 800 030 070), contact the front desk of your healthcare district (AUSL), or visit the website of the Agenzia delle Entrate.
What you need
ID documents, residence permit for foreign nationals, self-declaration of residence

General practitioner and Pediatrician

The family doctor or General Practitioner (MMG) serves the entire population over the age of 14. Nevertheless, in the period from age 6 to 14 the family is free to register a minor either with a GP or with a pediatrician. The Pediatrician (PLS) is the family doctor serving children from 0 to 14 years and is in charge of protecting them during their childhood, developmental age, and adolescence.
The GP clinic is open five days a week, from Monday to Friday. The reception opening times must be displayed at the entrance of the clinic. In case of need and/or upon request of the patient, the GP can arrange home visits.
After the examination, the GP may order the necessary treatment, further specialty consultations, lab tests, or the admission to a hospital.
If your GP works in partnership with a group of other GPs (i.e., Medicina in gruppo or Medicina in rete), for urgent visits or drug prescriptions you can also turn to a different GP belonging to the same group.
In case of absence, for annual or sick leave, GPs must inform their patients of the locum doctor they can contact. During night hours, on public holidays and days before holidays, for urgent problems you can contact the primary medical care doctor (guardia medica or medico di continuità assistenziale).

Registration with a GP or pediatrician

Registering with the Italian National Health System (and holding a health insurance card as proof of registration) gives you the right to register with a general practitioner (Medico di Medicina Generale – MMG) or pediatrician (Pediatra di Libera Scelta – PLS). Children from 0 to 6 years of age must register with a pediatrician. If no pediatrician is available in their district of residence, the provision of healthcare services will be guaranteed by the GP.
You can register with a GP or pediatrician in person, at the front desks of your healthcare district, via your online medical record (fascicolo sanitario elettronico – FSE) or via email.
In case you register with a GP after moving your residence from a Municipality in another Italian Region, you will be able to register with a GP in the new Municipality of residence by submitting the certificate proving that you canceled your registration with the previous healthcare district (AUSL).

Canceling the registration with a GP or Pediatrician

You may cancel your registration with your GP or pediatrician at any time by informing your healthcare district (AUSL). Such communication can be submitted by the patient directly, by the legal representative of the underage patient, or by a formally delegated person.
Obviously, once you cancel your registration, you will need to register with a new GP to maintain your right to access healthcare services without any interruption (see "registration with a GP").
You can cancel your registration with a GP also in case you change your domicile. In this case, the new District of residence may ask for a document proving such cancellation.
The interactive map "Cerca medico" allows you to search for a GP or pediatrician in the Emilia-Romagna Region and provides information such as location of the clinic, reception opening times, phone numbers, nearest clinic in your area. "Cerca medico" uses data from the Sole database, which gathers all GPs and pediatricians in our Region.

Primary medical care service

● Primary medical care over the phone
● Primary medical care clinics

This healthcare service is intended to integrate the medical assistance of GPs and pediatricians on the days and in the hours when they are absent, i.e., at night, on public holidays and days before holidays. It provides the same assistance as GPs and Pediatricians.
The primary medical care service (former Guardia medica) is available from 8 pm to 8 am on weekdays and from 8 am on Saturdays, or other days before holidays, until 8 am on Mondays, or the following weekday.
Phone calls to the primary medical care service are recorded to safeguard both the citizen and the Service. They are answered by the doctor in charge of the area. After collecting the patient’s personal data, the doctor assesses the health problem and may:

  1. Provide a relevant recommendation over the phone
  2. Instruct the patient to arrange an outpatient examination
  3. Decide that a home visit is appropriate

Primary medical care doctors can use the specific prescription pad (with the heading "Servizio Continuità assistenziale") to suggest an admission to the hospital, write a medical certificate for sick leave (max. 3 days), prescribe drugs for life-saving therapies so as to cover max. 48/72 hours. In most serious cases, the doctor will directly alert 118 so as to activate the ambulance service.

Reception opening times
Mon to Fri: 8 pm – 8 am
Sat and days before holidays: 8 am – 8 am of the following weekday

To access the service you need to call the phone number relevant to your geographical area.

District of Forlì

Tel. 800 533118

Municipalities covered
Bertinoro, Castrocaro Terme and Terra del Sole, Civitella di Romagna, Cusercoli, Dovadola, Forlì, Forlimpopoli, Galeata, Meldola, Modigliana, Portico and San Benedetto, Predappio, Premilcuore, Rocca San Casciano, Santa Sofia, Tredozio

District of Cesena

Tel. 800 050909

Municipalities covered
Bagno di Romagna, Borghi, Cesena, Cesenatico, Gambettola, Gatteo, Longiano, Mercato Saraceno, Montiano, Roncofreddo, San Mauro Pascoli, Sarsina, Savignano sul Rubicone, Sogliano al Rubicone, Valle del Savio, Verghereto

District of Ravenna

Tel. 800 244244

Municipalities covered
Alfonsine, Bagnacavallo, Bagnara di Romagna, Brisighella, Casola Valsenio, Castel Bolognese, Cervia, Conselice, Cotignola, Faenza, Fusignano, Lugo, Massa Lombarda, Ravenna, Riolo Terme, Russi, Sant'Agata sul Santerno, Solarolo

District of Rimini

Tel. +39 0541 787461

Municipalities covered
Bellaria Igea Marina, Casteldelci, Cattolica, Coriano, Gemmano, Maiolo, Misano Adriatico, Mondaino, Montefiore Conca, Montegridolfo, Montescudo-Monte Colombo, Montecopiolo, Morciano di Romagna, Novafeltria, Pennabilli, Poggio Torriana, Riccione, Rimini, Saludecio, San Clemente, San Giovanni in Marignano, San Leo, Sant’Agata Feltria, Santarcangelo di Romagna, Sassofeltrio, Talamello, Verucchio

Healthcare for immigrant women and their children

Immigrant women, with or without residence permit, can find medical assistance and counseling for themselves and their children by contacting the service for immigrant women and their children (Spazio per le donne immigrate e loro bambini) at the family counseling centers (Consultori familiari) or at the community pediatrics centers (Pediatrie di comunità).
Immigrant women, with or without residence permit, can find medical assistance and counseling for themselves and their children by contacting the service for immigrant women and their children (Spazio per le donne immigrate e loro bambini) at the family counseling center (Consultorio familiare).
This service provides women with assistance for pregnancy, voluntary abortion (IVG), menopause, birth control, and infertility. Midwives and gynecologists are available for counseling.
Children have access to pediatric examinations, health checks, vaccinations, and checkups for tuberculosis and infectious diseases. At the Spazio per le donne immigrate e loro bambini, an intercultural mediator is present to facilitate interactions.
In case a Spazio per le donne immigrate e loro bambini is not available, immigrant women can access these services at the Consultori familiari and Pediatrie di comunità.

What you need
Immigrants without residence permit need to hold a provisional STP card for foreign nationals provisionally living in Italy (Straniero temporaneamente presente).

Where to go
Consultorio familiare and Spazio donne immigrate e loro bambini

Healthcare for nomadic and non-EU children

Nomadic and non-EU children who have not registered with the National Health Service still receive medical and social assistance from community pediatrics centers (Pediatrie di comunità) and the service for immigrant women and their children (Spazio per le donne immigrate e loro bambini) of their healthcare district (Azienda Usl). Here, professionals will assess the children's needs, perform medical examinations, check their health, administer vaccinations, and check for infectious disease.

Support and counseling for young people

Young people, alone or as a couple (also in the absence of their parents), can find support at the Spazio Giovani of the family counseling center (Consultorio familiare). Here, they will find professionals sharing information, counseling, support regarding sex education, emotional and relationships management, contraception, and prevention. These are specifically trained professionals.
Further information on the web page of Spazio giovani, the counseling service for young people.

Contraceptive counseling

Professionals in family counseling services (Consultorio familiare, Spazio Giovani, and Spazio Giovani adulti e Spazio Donne Immigrate) must provide contraceptive counseling within 14 days and no later than 30 days after the patient’s request.
Services of contraceptive counseling can be provided by midwives or gynecologists.
The contraceptive counseling provided by midwives in family counseling centers is always free of charge.

The contraceptive counseling provided by gynecologists implies a co-payment; it is free of charge only for specific age groups and under certain conditions.
After receiving contraceptive counseling, you can obtain the following contraceptive methods free of charge (always for specific age groups and under certain conditions): hormonal (oral, transdermal, and vaginal), implantable, intrauterine (copper IUD or with progestin release), emergency contraception (hormonal or copper IUD), and female and male condoms.

Conditions for accessing contraceptive counseling by a gynecologist and contraceptives free of charge:
Citizens (male and female) under the age of 26
● Italian, EU and non-EU citizens registered with the SSN, RESIDING IN EMILIA-ROMAGNA AND REGISTERED WITH A LOCAL GP
● Asylum seekers or beneficiaries of subsidiary protection (permit for humanitarian reasons – PSU)
● Foreign citizens holding an STP card for foreign nationals provisionally living in Italy

Women between 26 and 45 years of age holding an E02 exemption (unemployment) or E99 exemption (workers hit by the crisis) in the 24 months following voluntary abortion or in the 12 months following childbirth:
● Italian, EU and non-EU citizens registered with the SSN, RESIDING IN EMILIA-ROMAGNA AND REGISTERED WITH A LOCAL GP
● Asylum seekers or beneficiaries of subsidiary protection (permit for humanitarian reasons – PSU)

If you access a Consultorio familiare with the prescription of a private gynecologist or other doctors outside the Consultorio, you cannot receive the contraceptive free of charge. To receive contraceptive methods free of charge you must have received contraceptive counseling from the family counseling services.
For more information, contact the family counseling services of your district of residence (see distribution facilities).

Obstetrical examination and counseling for pregnancy

Pregnant women can turn directly to the midwives of the family counseling center (Consultorio) to check their own and the fetus’ well-being free of charge, receive information about pregnancy and assistance during delivery (in hospital and at home), and to plan all checkups and specialty consultations.
This visit is part of the pathway to childbirth (percorso nascita), a method of coordinated support provided by different professionals and services dedicated to women, from the beginning of their pregnancy until after childbirth.

Emergency Department and Urgent treatment centers

Emergency Departments (Pronto Soccorso – PS) provide treatment to people who need urgent care.

For non-urgent cases, patients should contact their GP or the primary medical care doctor.

In case of inappropriate ED access, the patient will be charged a € 25 co-payment for the first examination of the emergency physician.
Urgent treatment centers (Punti di Primo Intervento – PPI) are equipped to examine and treat non-life-threatening emergencies. For more serious cases, they will stabilize patients and arrange their transfer to the most appropriate ED.
Here you can find the current number of "patients at the ED" divided per severity and priority code as assigned at triage, with indication of the average wait time in the last 24 hours.
Priority in the Emergency Department
People accessing the ED need treatment for life-threatening emergencies.
You can access the ED directly or, in most serious cases, calling 118 for an ambulance. When accessing ED services, you will be assessed and assigned a color coding your priority based on severity and urgency criteria:

red:

highly critical condition, requires immediate treatment

orange:

the treatment is urgent and cannot be postponed, critical condition, requires rapid care, wait time is 15 minutes max.

blue:

the treatment can be postponed, wait time is 60 minutes max.

green:

low-severity and low-priority condition, minor injury, 120 minutes

white:

non-life-threatening and non-urgent condition, 240 minutes

In case of non-life-threatening conditions, it is advisable to contact the GP directly.
Color coding is assigned during the triage phase. This assessment process guarantees that patients are treated consistently with priority and fairness criteria (color or numerical coding).
Patients are triaged by nurses, who assess their priority considering the main health problem, the urgency, the risk for the condition to get worse, and the most appropriate healthcare service. To assign a code, nurses consider other factors as well, i.e., pain intensity, age, patients’ fragility and/or impairment, management specifics, and local context. This is a dynamic process, meaning patients are periodically re-assessed to monitor any improvement or worsening of their clinical condition while awaiting the doctor’s examination and, if needed, consequently adjust their priority code and/or treatment.

Emergency Department co-payment

ED treatment is free of charge only in specifically defined cases. In case of inappropriate ED access, the patient will be charged a € 25 co-payment (ticket) for the first examination of the emergency physician.
Such co-payment is then added to:
● A further € 23 co-payment for any subsequent consultation the emergency physician may prescribe
● A maximum € 36.15 co-payment every eighth treatment of the same category (e.g., laboratory tests, diagnostic imaging) the emergency physician may prescribe, unless otherwise provided for in the relevant regulations (independently of the total value of those treatments’ fees).

In case of non-life-threatening conditions, it is advisable to contact the GP directly.
Color coding is assigned during the triage phase. This assessment process guarantees that patients are treated consistently with priority and fairness criteria (color or numerical coding).
Patients are triaged by nurses, who assess the priority considering the main health problem, the urgency, the risk that the condition gets worse, and the most appropriate healthcare service. To assign a code, nurses consider other factors as well, i.e., pain intensity, age, patients’ fragility and/or impairment, management specifics, and local context. This is a dynamic process, meaning patients are periodically re-assessed to monitor any improvement or worsening of their clinical conditions while awaiting the doctor’s examination and, if needed, consequently adjust their priority code and/or treatment.

Emergency Department co-payment

ED treatment is free of charge only in specifically defined cases. In case of inappropriate ED access, the patient will be charged a € 25 co-payment (ticket) for the first examination of the emergency physician.

Such co-payment is then added to:
● A further € 23 co-payment for any subsequent consultation the emergency physician may prescribe
● A maximum € 36.15 co-payment every eighth treatment of the same category (e.g., laboratory tests, diagnostic imaging) the emergency physician may prescribe, unless otherwise provided for in the relevant regulations (independently of the total value of those treatments’ fees).

The ED co-payment is not due in case of patients accessing the ED for:
● Trauma occurred in the previous 24 hours
● Trauma occurred before the previous 24 hours which led to a need for therapy
● Acute poisoning
● Accident at work
● Renal colic, asthma attack, chest pain, heart arrhythmia, acute glaucoma, intraocular foreign body, nosebleed, foreign body in the ear
● Postoperative complications requiring an access to the ED within 3 days after hospital discharge
● Problems or symptoms related to pregnancy.

Furthermore, the co-payment is not due by patients who:
● Stay in short-stay observation (Osservazione Breve Intensiva – OBI) to undergo further examinations or take drug therapies usually requiring a monitoring period of 6-24 hours
● Are admitted to any hospital ward
● Access the ED upon consultation with their GP / pediatrician, with the primary medical care doctor, or with a doctor of a different ED
● Are under the age of 14 years
● Are exempted from the co-payment because of illness, income level, or other reasons for exemptions as defined in national and regional regulations
● Are foreign nationals provisionally living in Italy (Straniero Temporaneamente Presente, STP) and are proven to be destitute.
Foreign nationals provisionally living in Italy can access healthcare services without showing any document proving their legal stay. Accessing healthcare services as irregular migrants in Emilia-Romagna does not imply being reported to the judicial authority.
For further information on the exemption from co-payment, please, call the reference toll-free phone number for the Regional Health Service: +39 800 033 033, Monday to Friday 8:30 am to 6 pm; Saturday 8:30 am to 1 pm.

Co-payment, contribution to healthcare costs and exemption criteria

What you need
To be exempted from co-payment, foreign nationals provisionally living in Italy (STP) must show their self-declaration of destitution and STP card. IRREGULAR MIGRANTS CAN SAFELY ACCESS THE FACILITIES OF THE REGIONAL HEALTHCARE SYSTEM: They can access healthcare services without showing any document proving their legal stay. Accessing healthcare services as irregular migrants in Emilia-Romagna cannot imply being reported to the judicial authority.
Relevant regulations
Law No 459 of 28 December 1995; Legislative Decree No 124 of 29 April 1998; Presidential Decree of 27 March 1992; Regional Circular letter No 16/1992; Regional Circular letter No 33/1993; Regional Council Decision No 264 of 24 February 2003; Regional Circular letter No 5 of 19 March 2003; Budget Law of 2007; Regional Council Decision No 1035/2009; Regional Council Decision No 389/2011, in force as of 1st May 2011

The Assistance and Urgency Centre (CAU)

is a healthcare facility with adequately trained primary care physicians and nurses, aimed at evaluating and assisting patients with urgent health issues that require a low complexity of care, 7 days a week with direct access.

CAUs can provide the following FREE services:

  • Medical examination
  • Certificates
  • Pharmacological treatment, if necessary
  • Prescriptions for the treatment of new-onset diseases or prescription of essential medicines
  • Minor surgical procedures (e.g. sutures, dressings)
  • Healthcare services and specialist services for traumas

Citizens accessing a CAU will be first evaluated by a nurse who will interview them to determine their healthcare needs, then they will be examined by a doctor and subsequently they may undergo further diagnostic examinations. The CAU doctor may refer the patient to specialists to complete the diagnostic evaluation, if necessary. The result of the clinical care pathway implemented at the CAU will be available in the citizen’s Electronic Health Record. After the diagnostic procedures have been performed, the medical report will have to be evaluated by the patient’s General Practitioner or Paediatrician of free choice, as they serve as reference for each citizen registered with the national health service, with no need for the citizen to go back to the CAU. The medical examination and some diagnostic tests provided by the CAU (for instance ECG and some blood tests) are free of charge for all citizens residing in the Region and /or registered with the local health centres, while for all others the examination will cost 20 euros, due upon receipt, to be paid to the doctor. Further specialist referrals from the CAU doctor for diagnostic completion are to be paid by the citizen as prescription charge.

The main symptoms that can be treated at a CAU are the following:

  • Headache/migraine (with mild-moderate pain)
  • Minor burns/Sunburns
  • Visual disturbances
  • Muscle contracture
  • Eye pain
  • Joint pain
  • Irritation from contact lenses
  • Diarrhoea (without blood)
  • Red eye with eye discharge/Conjunctivitis
  • Anal disorders
  • Eye trauma without visual disturbances
  • Abdominal pain (with mild-moderate pain)
  • Foreign body in the ear
  • Flank pain (such as renal colics)
  • Earache
  • Nausea and/or recurrent vomiting
  • Hearing loss/Ear wax blockage
  • Back pain/Lumbago
  • Nosebleed
  • Burning during urination/Urinary hesitancy
  • Toothache
  • Obstruction or replacement of bladder catheter
  • Problems after tooth extraction
  • Restlessness in previously known anxiety state
  • Stiff neck
  • Fever
  • Cough/Cold/Sore throat
  • Dressings and stitch removal
  • Minor traumas (Foot, Ankle, Knees, Elbow, Wrist, Hand)
  • Small wounds
  • Itching, redness/swelling of the skin
  • Change in blood sugar concentration
  • Insect bites, animal bites
  • Change in blood pressure

Attention! For serious health issues, such as chest pain, shortness of breath, unusual headaches, severe abdominal pain, it is always necessary to call 118. If a person accesses a CAU for a specific serious issue, such as chest pain or severe shortness of breath, the case will be immediately taken in charge by 118 for a hospital transfer.

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