NOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW
BAYCARE CLINIC, LLP AND BAYCARE HEALTH SYSTEMS, LLC MAY USE AND
DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS
TO THIS INFORMATION. IT ALSO DESCRIBES HOW BAYCARE CLINIC, LLP AND
BAYCARE HEALTH SYSTEMS, LLC, MAINTAINS WEB SITE AND INTERNET
PLEASE REVIEW IT CAREFULLY
BayCare Clinic LLP and BayCare Health Systems, LLC are required
by law to maintain the privacy of your protected health
information. This information consists of all records related to
your health, including demographic information, either created by
BayCare Clinic, LLP or BayCare Health Systems, LLC or received by
BayCare Clinic, LLP or BayCare Health Systems, LLC from other
We are required to provide you with notice of our legal duties
and privacy practices with respect to your protected health
information. These legal duties and privacy practices are described
in the Notice. BayCare Clinic, LLP and BayCare Health Systems, LLC
will abide by the terms of this Notice, or the Notice currently in
effect at the time of the use or disclosure of your protected
BayCare Clinic, LLP and BayCare Health Systems, LLC reserves the
right to change the terms of this Notice and to make any new
provisions effective for all protected health information that we
maintain. Patients will be provided a copy of any revised Notices
upon request. An individual may obtain a copy of the current Notice
from our office at any time.
Uses and Disclosures of Your Protected Health Information Not
Requiring Your Consent
BayCare Clinic, LLP and BayCare Health Systems, LLC may use and
disclose your protected health information, without your written
consent or authorization, for certain treatment, payment and
Treatment may include:
- Providing, coordinating, or managing healthcare and related
services by one or more healthcare providers;
- Consultations between healthcare providers concerning a
- Referrals to other providers for treatment;
- Referrals to nursing homes, foster care homes, or home health
- Providing basic information related to transportation needs
requested by the transporting agency
For example, BayCare Clinic, LLP or BayCare Health Systems, LLC
may determine you require the services of a specialist. In
referring you to another doctor, BayCare Clinic, LLP or BayCare
Health Systems, LLC may share or transfer your healthcare
information to that doctor.
Payment activities may include:
- Activities undertaken by BayCare Clinic, LLP or BayCare Health
Systems, LLC to obtain reimbursement for services provided to
- Determining your eligibility for benefits or health insurance
- Managing claims and contacting your insurance company regarding
- Collection activities to obtain payment for services provided
- Reviewing healthcare services and discussing with your
insurance company the medical necessity of certain services or
procedures, coverage under your health plan, appropriateness of
care, or justification of charges;
- Obtaining pre-certification and pre-authorization of services
to be provided to you.
For example, BayCare Clinic, LLP or BayCare Health Systems, LLC
will submit claims to your insurance company on your behalf. This
claim identifies you, your diagnosis, and the services provided to
Healthcare operations may include:
- Contacting healthcare providers and patients with information
about treatment alternatives;
- Conducting quality assessment and improvement activities;
- Recording of phone interactions to monitor quality of
- Conducting outcomes evaluation and development of clinical
- Protocol development, case management, or care
- Conducting or arranging for medical review, legal services, and
For example, BayCare Clinic, LLP and BayCare Health Systems, LLC
may use your diagnosis, treatment, and outcome information to
measure the quality of the services we provide, or assess the
effectiveness of your treatment when compared to patients in
BayCare Clinic, LLP and BayCare Health Systems, LLC may contact
you, by telephone or mail, to provide appointment reminders. You
must notify us in writing if you do not wish to receive appointment
We may not disclose your protected health information to family
members or friends who may be involved with your treatment or care
without your written permission. Health information may be released
without written permission to a parent, guardian, or legal
custodian or a child; the guardian of an incompetent adult; the
healthcare agent designated in an incapacitated patient's
healthcare power of attorney; or the personal representative or
spouse of a deceased patient.
There are certain restrictions on uses and disclosures of
treatment records, which include registration and all other records
concerning individuals who are receiving, or who at any time have
received services for mental illness, developmental disabilities,
alcoholism, or drug dependence. There are also restrictions on
disclosing HIV test results.
There are additional situations when BayCare Clinic, LLP and
BayCare Health Systems, LLC are permitted or required to use or
disclose your protected health information without your consent or
authorization. Examples include the following:
- As permitted or required by law.
In certain circumstances we may be required to report individual
health information to legal authorities, such as law enforcement
officials, court officials, or government agencies. For example, we
may have to report abuse, neglect, domestic violence or certain
physical injuries. We are required to report gunshot wounds or any
other wound to law enforcement officials if there is reasonable
cause to believe that the wound occurred as a result of a
Mental health records may be disclosed to law enforcement
authorities for the purpose of reporting an apparent crime on
- For public health activities.
We may release healthcare records, with the exception of
treatment records, to certain government agencies or public health
authority authorized by law, upon receipt of written request form
that agency. We are required to report positive HIV test results to
the state epidemiologist. We may also disclose HIV test results to
other providers or persons when there has been or will be risk of
exposure. We may report to the state epidemiologist the name of any
person known to have been significantly exposed to a patient who
tests positive for HIV.
We are required by law to report suspected child abuse and
neglect and suspected abuse of an unborn child, but cannot disclose
HIV test results in connection with the reporting or prosecution of
alleged abuse or neglect. We may release healthcare records,
including treatment records and HIV test results, to the Food and
Drug Administration when required by federal law. We may disclose
healthcare records, except for HIV test results, for the purpose of
reporting elder abuse or neglect, provided the subject of the abuse
or neglect agrees, or if necessary to prevent serious harm. Records
may be released for the reporting of domestic violence if necessary
to protect the patient or community from imminent and substantial
- For health oversight activities.
We may disclose healthcare records, including treatment records,
in response to a written request by any federal or state
governmental agency to perform legally authorized functions, such
as management audits, financial audits, program monitoring and
evaluation, and facility or individual licensure or certification.
HIV test results may not be released to federal or state
governmental agencies, without written permission, except to the
state epidemiologist for surveillance, investigation, or to control
- Judicial and Administrative Proceedings
Patient healthcare records, including treatment records and HIV
test results, may be disclosed pursuant to a lawful court order. A
subpoena signed by a judge is sufficient to permit disclosure of
all healthcare records except for HIV test results.
- For activities related to death.
We may disclose patient healthcare records, except treatment
records, to a coroner or medical examiner for the purpose of
completing a medical certificate or investigating a death. HIV test
results may be disclosed under certain circumstances.
Under certain circumstances, and only after a special approval
process, we may use and disclose your health information to help
- To avoid a serious threat to health or safety.
We may report a patient's name and other relevant data to the
Department of Transportation if it is believed the patient's vision
or physical or mental condition affects the patient's ability to
exercise reasonable or ordinary control over a motor vehicle.
Healthcare information, including treatment records and HIV test
results, may be disclosed where disclosure is necessary to protect
the patient or community from imminent and substantial danger.
- For workers' compensation.
We may disclose your health information to the extent such
records are reasonably related to any injury for which workers
compensation is claimed.
BayCare Clinic, LLP and BayCare Health Systems, LLC will not
make any other use or disclosure of your protected health
information without your written authorization except in the above
noted exceptions. Keep in mind, in an emergency healthcare
situation or when required by law, information may be released.
Uses of psychotherapy notes, disclosures of PHI for marketing
purposes and disclosures that constitute sale of PHI require an
authorization. You may revoke such authorization at any time,
except to the extent that BayCare Clinic, LLP or BayCare Health
Systems, LLC has taken action in reliance thereon. Any revocation
must be in writing.
Your Rights Regarding Your Protected Health
You are permitted to request that restrictions be placed on
certain uses or disclosures of your protected health information by
BayCare Clinic, LLP or BayCare Health Systems, LLC. This protected
heath information may include records of treatment, payment or
other healthcare operations.
You must request such a request in writing. We are not required
to agree to your request except for the release of your medical
records to your insurance company when:
- You have provided a written request AND
- You have personally (not via insurance of any sort) made
payment in full for those dates of service in question.
You have the right to review and/or obtain a copy of your
healthcare records, with the exception of psychotherapy notes, or
information compiled for use (or in anticipation for use) in a
civil, criminal, or administrative action or proceeding. BayCare
Clinic, LLP or BayCare Health Systems, LLC may deny an access under
other circumstances, in which case you have the right to have such
a denial reviewed. We may charge a reasonable fee for copying your
You may request that BayCare Clinic, LLP or BayCare Health
Systems, LLC send protected health information, including billing
information, to you by alternative means or to alternative
locations. You may also request that BayCare Clinic, LLP or BayCare
Health Systems, LLC not send information to a particular address or
location or contact you at a specific location, perhaps your place
of employment. This request must be submitted in writing. We will
accommodate reasonable requests by you.
You have the right to request that BayCare Clinic, LLP or
BayCare Health Systems, LLC amend portions of your healthcare
records, as long as such information is maintained by us. You must
submit this request in writing, and under certain circumstances the
request may be denied.
You may request to receive an accounting of the disclosures of
your protected health information made by BayCare Clinic, LLP or
BayCare Health Systems, LLC.
You may request and receive a paper copy of this Notice, if you
had previously received or agreed to receive the Notice
Any person or patient may file a complaint with BayCare Clinic,
LLP or BayCare Health Systems, LLC and/or the Secretary of Health
and Human Services if they believe their privacy rights have been
violated. To file a complaint with BayCare Clinic, LLP or BayCare
Health Systems, LLC, please contact the Privacy Official at the
BayCare Health Systems, LLC
BayCare Clinic, LLP
164 N. Broadway
Green Bay, WI 54303
It is the policy of BayCare Clinic, LLP and BayCare Health
Systems, LLC that no retaliatory action will be made against any
individual who submits or conveys a complaint of suspected or
actual non-compliance or violation of the privacy standards.
This Notice of Privacy Practices is effective April 14, 2003 and
revised January 2013.
This notice is prepared in accordance with the Health Insurance
Portability and Accountability Act, 45 C.F.R. 164.520, the Health
Information Technology for Economic & Clinical Health (HITECH)
Act, and applicable Wisconsin healthcare privacy law.