Orthopedic Walk-In Urgent Care: 9:00 AM to 3:00 PM, Monday through Thursday (Closed Fridays) @ the Prairie Ridge Clinic (262) 656-3590
Notice of Privacy Practices

Notice of Privacy Practices

THIS NOTICE OF PRIVACY PRACTICES ("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.

We are required by law to keep your health information private. We are also required by law to follow the terms of this Notice as long as it is in effect. If you have any questions about this Notice, please contact our Privacy Officer at 262-653-5377.

Who Will Follow This Notice?

Froedtert South, Inc. provides health care to our patients in partnership with physicians and other professionals and organizations. The privacy practices summarized in this Notice will be followed by:

  1. Treating health care professionals and others who enter information into the health record we maintain about you.
  2. Our employees, physicians, allied health professionals, students, and volunteers at any of our facilities.
  3. Our departments, clinics and units, at the Froedtert Kenosha Hospital and the Froedtert Pleasant Prairie Hospital and all off site clinics.
  4. Members of our organized health care arrangement with whom we share health information.
  5. Any business associate with whom we share health information.

This Notice applies to all of the records relating to your care maintained by Froedtert South, Inc. regardless of whether such records are generated by and/or received by Froedtert South, Inc. staff or your own doctor. However, please note that your doctor may have separate policies and/or notices about the use and disclosure of health information that is maintained in his or her private medical office.

How We May Use and Disclose Health Information About You

  1. We may use and disclose health information about you to:
    1. Provide you with medical treatment or services (such as sharing information with a consulting physician who has been asked to examine your health information). Unless you object, we also may share health information about you with people outside our organization who may be involved with your medical care after you leave the organization. These people include family members, home health agencies, nursing homes, or others who help provide services that are part of your ongoing care;
    2. Bill and collect payment from you, an insurance company or a third party. For example, we may need to give a health plan information about a procedure performed on you so that they will pay us, or reimburse you, for the cost of the procedure. We also may share health information with our business associates. Our business associates include billing companies, claims processing and pre-certification companies, collection agencies, clearing houses and others who need access to health information to perform their jobs; and
    3. To assist us with our healthcare operations. For example, we may use health information about you to review our treatment and services and/or to evaluate the performance of our staff.
  2. We may contact you to remind you that you have an appointment, to follow up on health care services that were provided to you, to tell you about treatment alternatives or to tell you about other health related benefits and services that may be of interest to you.
  3. We may contact you as part of our fundraising efforts. You may ask us not to contact you for this reason.
  4. Unless you object, we will make general information about you available to people who ask for you by name. This general information includes your name and location in the facility. This applies to all patients (such as in-patients, out-patients, and emergency room patients). Also, unless you object, this general information, including religious affiliation, also will be made available to clergy (such as a priest or rabbi) visiting the facility, even if they do not ask for you by name.
  5. We may share health information about you with family members or friends whom you indicate are involved in your medical care. In certain disasters and related emergency situations, we share health information about you with disaster relief organizations (such as the Red Cross, etc.) so that others can be notified about your condition, status and location.
  6. In certain situations, we may use and share health information about you for research purposes. However, all research projects are subject to a special review and approval process designed, among other things, to ensure the privacy of your health information. We may disclose health information about you to people preparing to conduct research (for example, to help them look for patients with specific medical needs).
  7. We may use or disclose health information about you without your permission only as allowed by law. Examples of situations where we may be required to release health information about you include: emergencies; public health investigations; health or safety threats; abuse or neglect investigations; health oversight and audit activities; national security concerns; coroners, medical examiners, funeral directors, organ/tissue donation needs; and workers' compensation claims. We also may be required by the law to provide health information about you in response to requests from law enforcement officials in limited circumstances, correctional institutions, or as part of legal proceedings in response to valid judicial or administrative orders and/or other valid legal authority.
  8. If you have paid in full out of pocket for a service or treatment and you have requested in writing that we do not disclose the associated health information to your health plan, we will not do so.

Other Uses of Health Information

Uses or disclosures of your health information that are not covered by this Notice or the law will be made only with your written permission. (This includes those used for marketing purposes other than materials sent to you about health care services or other treatment options.) In further support of your right to privacy, we cannot accept your blanket authorization to disclose health information for treatment you have not yet received. If you permit us to use or share health information about you, you may take back that permission, in writing, at any time. If you take back your permission, we will no longer use or share the health information you specified for the reasons you noted in writing. You understand that when you take back your permission, we are unable to retrieve any information we may have already shared with your permission. We are required to maintain records of the care that we provide to you. We are required to inform you if there is a breach of your health information. Froedtert South, Inc. participates in the Wisconsin Statewide Health Information Network (WISHIN). Through WISHIN, Froedtert South, Inc. makes your medical information available electronically to public health entities, as permitted by law, and to other health care providers and health plans for purposes of treatment, payment, and health care operations. Froedtert South, Inc. also uses WISHIN to obtain information about you from your other health care providers. You may opt out of having your information shared through WISHIN by going to www.wishin.org/For Patients or by calling WISHIN at 1-888-WISHIN1 (1-888-947-4461).

Your Rights Regarding Health Information About You

  1. You have the right to see and receive a copy of health information about you. To do so, you must submit your request in writing to Froedtert South, Inc., Medical Records Department at 6308 Eighth Avenue, Kenosha, Wisconsin 53143. If you request a copy, it must be requested in advance and we may charge a fee for the cost of copies, postage and/or other supplies. In certain situations, we may deny your request. If we deny your request, we will tell you, in writing, why your request was denied and explain to you your right to have the denial reviewed.
  2. If you feel that our record of your health information is incorrect or incomplete, you have the right to request to amend the information. You may do this by sending your request in writing to Froedtert South, Inc. Privacy Officer at 6308 Eighth Avenue, Kenosha, Wisconsin 53143, including your reason for the request. We may deny your request if the information was not created by us, is not part of the health information maintained by us, or if it is determined that the health information is correct. You may appeal our decision by sending a written request to us.
  3. You have the right to request a list of all of our disclosures of your health information, except for information disclosed for treatment, payment or health care operations, or for those disclosures you specifically authorized. To request this list, you must send your request in writing to Froedtert South, Inc. Privacy Officer at 6308 Eighth Avenue, Kenosha, Wisconsin 53143. Your request must tell us a specific time period (beginning after April 14, 2003) of not more than six years. The first disclosure list you request in any 12-month period is free. We may charge a fee for additional lists.
  4. You have the right to ask that we limit how we use and disclose health information about you. You may do so by submitting a request in writing to Froedtert South, Inc. Privacy Officer at 6308 Eighth Avenue, Kenosha, Wisconsin 53143, telling us how and what information to limit. We will consider your request but are not legally required to accept it. We also are not required to agree to your request. If we do agree, we will follow your request unless the information is needed to provide you with emergency treatment.
  5. You have the right to ask us to send information to you at a different address or telephone number (for example, sending information to your work address instead of your home address) or in a different way (for example, in an unmarked envelope instead of our regular mailing envelope). You may do so by sending a request in writing to Froedtert South, Inc. Privacy Officer at 6308 Eighth Avenue, Kenosha, Wisconsin 53143. We have the right to decide whether the request is reasonable. We do not have to comply with an unreasonable request.
  6. You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.

Complaints

If you feel that your privacy rights have been violated, you may file a complaint in writing to Froedtert South, Inc. Privacy Officer at 6308 Eighth Avenue, Kenosha, Wisconsin 53143. You also may file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

Changes to This Notice

We reserve the right to change this Notice and our privacy policies at any time. Before we make an important change to our policies, we will revise this Notice. Any changes will apply to the health information we have on file and health information we create or receive after the effective date of the new Notice. You may request a copy of the current Notice from the Privacy Officer. The effective date of this Notice is January 1, 2021.

1/2021

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