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Privacy Officer Name and Contact Information:
Liz Hildebrandt, RN, BSN, Nurse Manager (920.452.4673)
Effective Date: November 6, 2017
NOTICE OF PRIVACY PRACTICES1

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights
You have the right to:

Your Choices
You have some choices in the way that we use and share information as we:

Our Uses and Disclosures
We may use and share your information as we:

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you including getting an electronic or paper copy of your medical record.

Ask us to correct your medical record

Request confidential communications

Ask us to limit what we use or share

Get a list of those with whom we’ve shared information

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you feel your rights are violated

Your Choices

For certain health information, you can tell us your choices about what we share. If you

have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

In these cases, we never share your information unless you give us written permission:

In the case of fundraising:

Our Uses and Disclosures

How do we typically use or share your health information?
We use or share your health information in the following ways:

Provide services for you

Run our organization

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

Do research

Comply with the law

Work with a medical examiner or funeral director

Address workers’ compensation, law enforcement, and other government requests

Respond to lawsuits and legal actions

Our Responsibilities

Changes to the Terms of this Notice

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