Click here to download or print Privacy Notice (Adobe Acrobat PDF).
Each time you visit a Bellin Health facility or a Bellin Health provider for health care, a record of your visit is made. This record usually contains identification and financial information, as well as health information such as symptoms, diagnoses, test results, a description of the physical examination, and a treatment plan. This record of information is often referred to as your “medical record,” or “health information.” The following are examples of the purposes for which this information is used:
Bellin Health has always worked to protect your health information and will continue to do so. In addition, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) now requires Bellin Health to provide you with this notice describing our legal duties and privacy practices concerning your health information, as well as your rights related to your health information. This notice applies to all records of your health information held by Bellin Health, regardless of whether the record is written, computerized, or in any other form. We are required by law to keep your health information private and to follow the terms of this notice, or any revised version of this notice that is in effect.
Bellin Health reserves the right to change the privacy practices described in this notice and to change this notice to reflect our revised privacy practices. Changes to our privacy practices would apply to all health information maintained by us, including that which we obtained prior to changing this notice. If we change our privacy practices, you may read a summary of substantive changes on our website at www.bellin.org. You may obtain a revised copy of the privacy notice at the front desk of any of our facilities or on our website at www.bellin.org.
All of the below listed organizations and individuals agree to abide by the terms of this notice. These organizations and individuals will share your health information with each other as necessary for your treatment, to get paid for services, and to carry out health care operations activities such as quality assessment and improvement activities.
This notice covers the privacy practices of Bellin Health, which includes the health care professionals, including students, employees, other personnel, and volunteers providing services at Bellin Health. Bellin Health is several separate, but related organizations, which provide quality health care, train future health care professionals (such as doctors, nurses, and radiology technicians), and conduct health sciences research. Bellin Health is made up of the following organizations:
This notice also covers the privacy practices of all other providers approved to practice at any Bellin Health facility listed above. These providers include area physicians, podiatrists, dentists, nurse practitioners, physician assistants, and other health care professionals. References to “we,” “us,” or “our” in this notice mean the individuals and entities described above.
This notice does not apply to care you receive from other providers in their personal offices or at other locations than the sites described above. Your providers may have their own polices and procedures that apply to your health information that they record or maintain outside of Bellin Health. You should review your provider’s notice for information on how he or she will handle your health information outside of Bellin Health sites.
We participate in an arrangement with ThedaCare to help facilitate access to health information that may be needed to provide you with care. As part of this arrangement, we have agreed to store health information of our patients in a jointly shared electronic medical record with the other health care provider participants in this arrangement. When it is needed, this shared electronic medical record will provide participants with access to health information essential to providing you with medical care. The need for this could occur, for example, if you were admitted to a hospital on an emergency basis and you were unconscious and could not provide important information about your health condition. Each participant in the shared electronic medical record has implemented policies and procedures governing appropriate access to health information in the shared electronic medical record in accordance with state and federal law. Any access to your health information that we store in the shared electronic medical record by a non-Bellin Health participant will only be made for the purposes described in this notice.
We are able to use your health information without your written authorization for the following purposes:
We may use health information about you to provide medical treatment or health care services. We may disclose health information about you to doctors, nurses, technicians, students preparing for health care related careers, or other personnel who are involved in your care or treatment, including your primary care physician. For example, a physician may use the information in your medical record to determine which treatment option, such as a drug or surgery, best addresses your health needs. The treatment selected will be documented in your medical record, so that other health care professionals can make informed decisions about your care. Different departments within Bellin Health may share health information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. At shift change we will provide information to health care personnel that are vital for your care. For example, a respiratory therapist will provide a report about you to the next therapist who will be taking care of you. We may also share your health information in person or by phone, letter, fax, or electronically to people outside of Bellin Health who are involved in your medical care, such as your primary or referring physician, a long-term care facility, others we work with to provide services that are part of your care.
We may use and disclose your health information as necessary to obtain payment for the health care services we provide to you. Here are some cases where we use your health information without your written authorization for payment purposes. To check eligibility or to determine whether your insurance company will pay for the treatment, Bellin Health will tell your health insurance company about your treatment plan. Most of the time, this information is provided electronically (by computer), or by fax and or telephone.
In order for an insurance company or another agency to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the treatment provided to you. As a result, we will disclose necessary health information to an insurer or another agency for Bellin Health to receive payment for your medical bills.
We may use and disclose your health information for our organizational operations related to providing health care. Here are some cases where we use your health information without your written authorization for our operational purposes. We may need your diagnosis, treatment, and outcome information in order to improve the quality or cost of care delivered by us. These quality and cost improvement activities include evaluating the performance of your physicians, nurses, and other health care professionals, or examining the effectiveness of the treatment provided to you when compared to other patients in similar situations. We contract with reputable and credible companies to help us analyze our data and compare ourselves to other health care providers to see where we can make improvements in the care and services we offer. We may also remove information that identifies you from this set of your health information so others may use it to study health care without learning your identity.
Bellin Health will also use or disclose your health information for teaching purposes, administrative activities, or for accreditation, certification, or licensing purposes. To remind you of your appointments for visits, tests and treatments, we may use your health information for appointment reminders. For example, we will view your medical record to determine the date and time of your next appointment with us, and then send you a reminder letter or call you to remind you of the appointment.
We will want to let you know of other treatments or services we offer that may improve or benefit your health. For example, we may notify patients with poor circulation to their legs of a new program we offer that might help them. We may communicate to you about good health practices, such as a mailing with information about how to lower cholesterol or stop smoking, and about health fairs, wellness classes, or support groups that we offer.
In order to provide more charity care or otherwise improve the health of your community, we may use your health information (for example, your name, address, phone number, and treatment dates) to contact you for fundraising purposes. You may opt-out of receiving any further fundraising communications from us by notifying us at Bellin Health 744 S. Webster Avenue, Green Bay WI 54305 (Attention Privacy Officer) in writing of your request to opt-out.
Here are some other special instances when we can use and disclose your health information without your written authorization:
When Bellin Health is required to obtain your authorization to use or disclose your health information:
Except for the situations listed above, any other use or disclosure of your health information requires us to obtain your specific written authorization.
Some types of health information are specially protected under other state or federal laws and those laws may impose more restrictive requirements on disclosure of this information, even for purposes described above. When those more restrictive laws apply, we may need your specific written authorization to release these types of health information, even in some cases, for the purposes of treatment, payment, and health care operations. The types of health information that are subject to additional restrictions include HIV test results, and information related to treatment for mental illness, developmental disability, or alcohol or drug abuse.
We must obtain your written authorization for most uses or disclosures of the following: (1) psychotherapy notes; (2) uses or disclosures of your health information for marketing purposes; and (3) disclosures of your health information in exchange for direct or indirect remuneration to Bellin Heath.
If you do sign an authorization form, you may withdraw your authorization at any time, as long as your withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to the Medical Records department at Bellin Hospital or to the Bellin site where you signed the authorization form. Please understand that we cannot take back any disclosures that were made before you withdrew your authorization.
You have several rights with regard to your health information. If you wish to exercise any of the following rights, please contact the Bellin Health Privacy Officer at (920) 433-3595. Specifically, you have the right:
If you have any questions or concerns regarding your privacy rights or the information in this notice, please contact the Bellin Health Privacy Officer at (920) 433-3595.