What the statutes mean

Informed consent

Under most circumstances, a chiropractor must keep the health care records of an individual confidential and must have the informed consent of a patient to release their health care records to anyone but the patient. Informed consent means written consent to the disclosure of information from their health care records to an individual, agency or organization. The consent must include the following information:

• The name of the patient whose record is being disclosed.

• The type of information to be disclosed.

• The types of health care providers making the disclosure.

• The purpose of the disclosure such as whether the disclosure is for further medical care, for an application for insurance, to obtain payment of an insurance claim, for a disability determination, for a vocational rehabilitation evaluation, for a legal investigation or for other specified purposes.

• The individual, agency or organization to which disclosure may be made.

• The signature of the patient or the person authorized by the patient and, if signed by a person authorized by the patient, the relationship of that person to the patient or the authority of the person. Parents, guardians, or legal custodians may sign on the behalf of children.

• The date on which the consent is signed.

• The time period during which the consent is effective.

A patient’s health care records means all of the clinical records in your possession including health care records you obtained from another chiropractor or medical doctor.

Access without informed consent.

The law provides exceptions where records must be released even if the patient does not give their consent. The most common exceptions are:

• Any person under your supervision including all members of your staff.

• Records requested by a worker’s compensation carrier for a patient on whose behalf you have a worker’s compensation claim.

• To health care facility staff committees, or accreditation or health care services review organizations for the purposes of conducting management audits, financial audits, program monitoring and evaluation, health care services reviews or accreditation.

• To the extent that the records are needed for billing, collection or payment of claims.

• Under a lawful order of a court.

• In response to a written request by any federal or state governmental agency to perform a legally authorized function, including Medicare and Medical Assistance audits.

• For purposes of research if the researcher is affiliated with the chiropractor and provides written assurances that the information will be used only for the purposes for which it is provided to the researcher, the information will not be released to a person not connected with the study, and the final product of the research will not reveal information that may serve to identify the patient whose records are being released without the informed consent of the patient. A private pay patient may deny access granted under this subdivision by annually submitting a signed, written request to you.

• Records requested as part of an investigation of an abused or neglected child.

• To the department or to a sheriff, police department or district attorney for purposes of investigation of a death.

• To a designated representative of the long-term care ombudsman, for the purpose of protecting and advocating the rights of an individual 60 years of age or older who resides in a long-term care facility.

• Following the death of a patient, to a coroner, deputy coroner, medical examiner or medical examiner’s assistant, for the purpose of completing a medical certificate or investigating a death.

If you release records under any of the exceptions noted above, you are required to record the name of the person or agency to which the records were released, the date and time of the release and, the identification of the records released.

Reports made without informed consent.

If you are treating a patient whose physical or mental condition affects the patient’s ability to exercise reasonable and ordinary control over a motor vehicle, you may report the patient’s name and other information relevant to the condition to the department of transportation without the informed consent of the patient.

Access to patient health care records.

Any patient, or other person that has the informed consent of the patient, may:

 

• Upon reasonable notice, inspect the health care records of the patient at any time during regular business hours.

• Receive a copy of the patient’s health care records upon payment of reasonable costs.

• Receive a copy of the health care provider’s X-ray reports or have the X-rays referred to another health care provider of the patient’s choice upon payment of reasonable costs.

You must provide each patient with a statement paraphrasing the provisions of this law at the time you first provide services to the patient.

You are required to note the time and date of each request by a patient or person authorized by the patient to inspect the patient’s health care records, the name of the inspecting person, the time and date of inspection and identify the records released for inspection.

You may never do any of the following:

• Intentionally falsify a patient health care record.

• Conceal or withhold a patient health care record with intent to prevent or obstruct an investigation or prosecution or with intent to prevent its release to the patient, or another authorized person.

• Intentionally destroy or damage records in order to prevent or obstruct an investigation or prosecution.

Preservation or destruction of patient health care records.

A chiropractor who ceases practice, or the personal representative of a chiropractor, must do one of the following for all patient health care records when the chiropractor ceased practice or died:

• Provide for the maintenance of the patient health care records by a person who states, in writing, that the records will be maintained in compliance with law as detailed below.

• Provide for the deletion or destruction of the patient health care records.

• Provide for the maintenance of some of the patient health care records, and for the deletion or destruction of some of the records, as detailed below.

Maintenance of records

If the chiropractor’s personal representative provides for the maintenance of any of the patient health care records, he or she must do at least one of the following:

• Provide written notice, by 1st class mail, to each patient whose records will be maintained. The notice must be sent to the patient’s last-known address describing where and who will maintain the records.

• Publish a class 3 notice in a newspaper in the county in which the chiropractor’s practice was located, specifying where and by whom the patient health care records will be maintained.

Destruction of records

If the chiropractor or personal representative provides for the deletion or destruction of any of the patient health care records, they must also do at least one of the following:

• Provide notice to each patient that their records will be deleted or destroyed. The written notice must be sent by first class mail at least 35 days prior to deleting or destroying the records, to the last-known address of the patient. The notice must inform the patient of the date on which the records will be deleted or destroyed and where the records may be retrieved before that date.

• Publish, a class 3 notice in a newspaper that is published in the county in which the chiropractor’s practice was located, specifying the date on which the records will be deleted or destroyed, and where the records may be retrieved prior to that date.

Statute excerpts

146.819 Preservation or destruction of patient health care records
146.82 Confidentiality of patient health care records
146.82(2) Access without informed consent
146.82(3) Reports made without informed consent
146.83 Access to patient health care records

146.81(2) “Informed consent” means written consent to the disclosure of information from patient health care records to an individual, agency or organization that includes all of the following:

146.81(2)(a) The name of the patient whose record is being disclosed.

146.81(2)(b) The type of information to be disclosed.

146.81(2)(c) The types of health care providers making the disclosure.

146.81(2)(d) The purpose of the disclosure such as whether the disclosure is for further medical care, for an application for insurance, to obtain payment of an insurance claim, for a disability determination, for a vocational rehabilitation evaluation, for a legal investigation or for other specified purposes.

146.81(2)(e) The individual, agency or organization to which disclosure may be made.

146.81(2)(f) The signature of the patient or the person authorized by the patient and, if signed by a person authorized by the patient, the relationship of that person to the patient or the authority of the person.

146.81(2)(g) The date on which the consent is signed.

146.81(2)(h) The time period during which the consent is effective.

146.81(3) “Patient” means a person who receives health care services from a health care provider.

146.81(4) “Patient health care records” means all records related to the health of a patient prepared by or under the supervision of a health care provider, including the records required under s. 146.82 (2) (d) and (3) (c), but not those records subject to s. 51.30, reports collected under s. 69.186, records of tests administered under s. 252.15 (2) (a) 7., 343.305, 938.296 (4) or 968.38 (4), fetal monitor tracings, as defined under s. 146.817 (1), or a pupil’s physical health records maintained by a school under s. 118.125.

146.81(5) “Person authorized by the patient” means the parent, guardian or legal custodian of a minor patient, as defined in s. 48.02 (8) and (11), the person vested with supervision of the child under s. 938.183 or 938.34 (4d), (4h), (4m) or (4n), the guardian of a patient adjudged incompetent, as defined in s. 880.01 (3) and (4), the personal representative or spouse of a deceased patient, any person authorized in writing by the patient or a health care agent designated by the patient as a principal under ch. 155 if the patient has been found to be incapacitated under s. 155.05 (2), except as limited by the power of attorney for health care instrument. If no spouse survives a deceased patient, “person authorized by the patient” also means an adult member of the deceased patient’s immediate family, as defined in s. 632.895 (1) (d). A court may appoint a temporary guardian for a patient believed incompetent to consent to the release of records under this section as the person authorized by the patient to decide upon the release of records, if no guardian has been appointed for the patient.

Preservation or destruction of patient health care records.

146.819(1) Except as provided in sub. (4), any health care provider who ceases practice or business as a health care provider or the personal representative of a deceased health care provider who was an independent practitioner shall do one of the following for all patient health care records in the possession of the health care provider when the health care provider ceased business or practice or died:

146.819(1)(a) Provide for the maintenance of the patient health care records by a person who states, in writing, that the records will be maintained in compliance with ss. 146.81 to 146.835.

146.819(1)(b)Provide for the deletion or destruction of the patient health care records.

146.819(1)(c) Provide for the maintenance of some of the patient health care records, as specified in par. (a), and for the deletion or destruction of some of the records, as specified in par. (b).

146.819(2) If the health care provider or personal representative provides for the maintenance of any of the patient health care records under sub. (1), the health care provider or personal representative shall also do at least one of the following:

146.819(2)(a) Provide written notice, by 1st class mail, to each patient or person authorized by the patient whose records will be maintained, at the last-known address of the patient or person, describing where and by whom the records shall be maintained.

146.819(2)(b) Publish, under ch. 985, a class 3 notice in a newspaper that is published in the county in which the health care provider’s or decedent’s health care practice was located, specifying where and by whom the patient health care records shall be maintained.

146.819(3) If the health care provider or personal representative provides for the deletion or destruction of any of the patient health care records under sub. (1), the health care provider or personal representative shall also do at least one of the following:

146.819(3)(a) Provide notice to each patient or person authorized by the patient whose records will be deleted or destroyed, that the records pertaining to the patient will be deleted or destroyed. The notice shall be provided at least 35 days prior to deleting or destroying the records, shall be in writing and shall be sent, by 1st class mail, to the last-known address of the patient to whom the records pertain or the last-known address of the person authorized by the patient. The notice shall inform the patient or person authorized by the patient of the date on which the records will be deleted or destroyed, unless the patient or person retrieves them before that date, and the location where, and the dates and times when, the records may be retrieved by the patient or person.

146.819(3)(b) Publish, under ch. 985, a class 3 notice in a newspaper that is published in the county in which the health care provider’s or decedent’s health care practice was located, specifying the date on which the records will be deleted or destroyed, unless the patient or person authorized by the patient retrieves them before that date, and the location where, and the dates and times when, the records may be retrieved by the patient or person.

Confidentiality of patient health care records.

146.82(1) All patient health care records shall remain confidential. Patient health care records may be released only to the persons designated in this section or to other persons with the informed consent of the patient or of a person authorized by the patient. This subsection does not prohibit reports made in compliance with s. 146.995 or 979.01 or testimony authorized under s. 905.04 (4) (h).

Access without informed consent.

146.82(2)(a)Notwithstanding sub. (1), patient health care records shall be released upon request without informed consent in the following circumstances:

146.82(2)(a)1. To health care facility staff committees, or accreditation or health care services review organizations for the purposes of conducting management audits, financial audits, program monitoring and evaluation, health care services reviews or accreditation.

146.82(2)(a)2.To the extent that performance of their duties requires access to the records, to a health care provider or any person acting under the supervision of a health care provider or to a person licensed under s. 146.50, including but not limited to medical staff members, employees or persons serving in training programs or participating in volunteer programs and affiliated with the health care provider, if:

146.82(2)(a)2.a. The person is rendering assistance to the patient;

146.82(2)(a)2.b. The person is being consulted regarding the health of the patient; or

146.82(2)(a)2.c. The life or health of the patient appears to be in danger and the information contained in the patient health care records may aid the person in rendering assistance.

146.82(2)(a)2.d. The person prepares or stores records, for the purposes of the preparation or storage of those records.

146.82(2)(a)3.To the extent that the records are needed for billing, collection or payment of claims.

146.82(2)(a)4.Under a lawful order of a court of record.

146.82(2)(a)5.In response to a written request by any federal or state governmental agency to perform a legally authorized function, including but not limited to management audits, financial audits, program monitoring and evaluation, facility licensure or certification or individual licensure or certification. The private pay patient, except if a resident of a nursing home, may deny access granted under this subdivision by annually submitting to a health care provider, other than a nursing home, a signed, written request on a form provided by the department. The provider, if a hospital, shall submit a copy of the signed form to the patient’s physician.

146.82(2)(a)6. For purposes of research if the researcher is affiliated with the health care provider and provides written assurances to the custodian of the patient health care records that the information will be used only for the purposes for which it is provided to the researcher, the information will not be released to a person not connected with the study, and the final product of the research will not reveal information that may serve to identify the patient whose records are being released under this paragraph without the informed consent of the patient. The private pay patient may deny access granted under this subdivision by annually submitting to the health care provider a signed, written request on a form provided by the department.

146.82(2)(a)7.To a county agency designated under s. 46.90 (2) or other investigating agency under s. 46.90 for purposes of s. 46.90 (4) (a) and (5) or to the county protective services agency designated under s. 55.02 for purposes of s. 55.043. The health care provider may release information by initiating contact with the county agency or county protective services agency without receiving a request for release of the information from the county agency or county protective services agency.

146.82(2)(a)8.To the department under s. 255.04. The release of a patient health care record under this subdivision shall be limited to the information prescribed by the department under s. 255.04 (2).

146.82(2)(a)9.a. In this subdivision, “abuse” has the meaning given in s. 51.62 (1) (ag); “neglect” has the meaning given in s. 51.62 (1) (br); and “parent” has the meaning given in s. 48.02 (13), except that “parent” does not include the parent of a minor whose custody is transferred to a legal custodian, as defined in s. 48.02 (11), or for whom a guardian is appointed under s. 880.33.

146.82(2)(a)9.b. Except as provided in subd. 9. c. and d., to staff members of the protection and advocacy agency designated under s. 51.62 (2) or to staff members of the private, nonprofit corporation with which the agency has contracted under s. 51.62 (3) (a) 3., if any, for the purpose of protecting and advocating the rights of a person with developmental disabilities, as defined under s. 51.62 (1) (am), who resides in or who is receiving services from an inpatient health care facility, as defined under s. 51.62 (1) (b), or a person with mental illness, as defined under s. 51.62 (1) (bm).

146.82(2)(a)9.c. If the patient, regardless of age, has a guardian appointed under s. 880.33, or if the patient is a minor with developmental disability, as defined in s. 51.01 (5) (a), who has a parent or has a guardian appointed under s. 48.831 and does not have a guardian appointed under s. 880.33, information concerning the patient that is obtainable by staff members of the agency or nonprofit corporation with which the agency has contracted is limited, except as provided in subd. 9. e., to the nature of an alleged rights violation, if any; the name, birth date and county of residence of the patient; information regarding whether the patient was voluntarily admitted, involuntarily committed or protectively placed and the date and place of

admission, placement or commitment; and the name, address and telephone number of the guardian of the patient and the date and place of the guardian’s appointment or, if the patient is a minor with developmental disability who has a parent or has a guardian appointed under s. 48.831 and does not have a guardian appointed under s. 880.33, the name, address and telephone number of the parent or guardian appointed under s. 48.831 of the patient.

146.82(2)(a)9.d. Except as provided in subd. 9. e., any staff member who wishes to obtain additional information about a patient described in subd. 9. c. shall notify the patient’s guardian or, if applicable, parent in writing of the request and of the guardian’s or parent’s right to object. The staff member shall send the notice by mail to the guardian’s or, if applicable, parent’s address. If the guardian or parent does not object in writing within 15 days after the notice is mailed, the staff member may obtain the additional information. If the guardian or parent objects in writing within 15 days after the notice is mailed, the staff member may not obtain the additional information.

146.82(2)(a)9.e. The restrictions on information that is obtainable by staff members of the protection and advocacy agency or private, nonprofit corporation that are specified in subd. 9. c. and d. do not apply if the custodian of the record fails to promptly provide the name and address of the parent or guardian; if a complaint is received by the agency or nonprofit corporation about a patient, or if the agency or nonprofit corporation determines that there is probable cause to believe that the health or safety of the patient is in serious and immediate jeopardy, the agency or nonprofit corporation has made a good-faith effort to contact the parent or guardian upon receiving the name and address of the parent or guardian, the agency or nonprofit corporation has either been unable to contact the parent or guardian or has offered assistance to the parent or guardian to resolve the situation and the parent or guardian has failed or refused to act on behalf of the patient; if a complaint is received by the agency or nonprofit corporation about a patient or there is otherwise probable cause to believe that the patient has been subject to abuse or neglect by a parent or guardian; or if the patient is a minor whose custody has been transferred to a legal custodian, as defined in s. 48.02 (11) or for whom a guardian that is an agency of the state or a county has been appointed.

146.82(2)(a)10. To persons as provided under s. 655.17 (7) (b), as created by 1985 Wisconsin Act 29, if the patient files a submission of controversy under s. 655.04 (1), 1983 stats., on or after July 20, 1985 and before June 14, 1986, for the purposes of s. 655.17 (7) (b), as created by 1985 Wisconsin Act 29.

146.82(2)(a)11. To a county department, as defined under s. 48.02 (2g), a sheriff or police department or a district attorney for purposes of investigation of threatened or suspected child abuse or neglect or suspected unborn child abuse or for purposes of prosecution of alleged child abuse or neglect, if the person conducting the investigation or prosecution identifies the subject of the record by name. The health care provider may release information by initiating contact with a county department, sheriff or police department or district attorney without receiving a request for release of the information. A person to whom a report or record is disclosed under this subdivision may not further disclose it, except to the persons, for the purposes and under the conditions specified in s. 48.981 (7).

146.82(2)(a)12.To a school district employee or agent, with regard to patient health care records maintained by the school district by which he or she is employed or is an agent, if any of the following apply:

146.82(2)(a)12.a. The employee or agent has responsibility for preparation or storage of patient health care records.

146.82(2)(a)12.b. Access to the patient health care records is necessary to comply with a requirement in federal or state law.

146.82(2)(a)13.To persons and entities under s. 940.22.

146.82(2)(a)14. To a representative of the board on aging and long-term care, in accordance with s. 49.498 (5) (e).

146.82(2)(a)15. To the department under s. 48.60 (5) (c), 50.02 (5) or 51.03 (2) or to a sheriff, police department or district attorney for purposes of investigation of a death reported under s. 48.60 (5) (a), 50.035 (5) (b), 50.04 (2t) (b) or 51.64 (2).

146.82(2)(a)16. To a designated representative of the long-term care ombudsman under s. 16.009 (4), for the purpose of protecting and advocating the rights of an individual 60 years of age or older who resides in a long-term care facility, as specified in s. 16.009 (4) (b).

146.82(2)(a)17. To the department under s. 50.53 (2).

146.82(2)(a)18. Following the death of a patient, to a coroner, deputy coroner, medical examiner or medical examiner’s assistant, for the purpose of completing a medical certificate under s. 69.18 (2) or investigating a death under s. 979.01 or 979.10. The health care provider may release information by initiating contact with the office of the coroner or medical examiner without receiving a request for release of the information and shall release information upon receipt of an oral or written request for the information from the coroner, deputy coroner, medical examiner or medical examiner’s assistant. The recipient of any information under this subdivision shall keep the information confidential except as necessary to comply with s. 69.18, 979.01 or 979.10.

146.82(2)(a)18m. If the subject of the patient health care records is a child or juvenile who has been placed in a foster home, treatment foster home, group home, child caring institution or a secured correctional facility, including a placement under s. 48.205, 48.21, 938.205 or 938.21 or for whom placement in a foster home, treatment foster home, group home, child caring institution or secured correctional facility is recommended under s. 48.33 (4), 48.425 (1) (g), 48.837 (4) (c) or 938.33 (3) or (4), to

an agency directed by a court to prepare a court report under s. 48.33 (1), 48.424 (4) (b), 48.425 (3), 48.831 (2), 48.837 (4) (c) or 938.33 (1), to an agency responsible for preparing a court report under s. 48.365 (2g), 48.425 (1), 48.831 (2), 48.837 (4) (c) or 938.365 (2g), to an agency responsible for preparing a permanency plan under s. 48.355 (2e), 48.38, 48.43 (1) (c) or (5) (c), 48.63 (4), 48.831 (4) (e), 938.355 (2e) or 938.38 regarding the child or juvenile or to an agency that placed the child or juvenile or arranged for the placement of the child or juvenile in any of those placements and, by any of those agencies, to any other of those agencies and, by the agency that placed the child or juvenile or arranged for the placement of the child or juvenile in any of those placements, to the foster parent or treatment foster parent of the child or juvenile or the operator of the group home, child caring institution or secured correctional facility in which the child or juvenile is placed, as provided in s. 48.371 or 938.371.

146.82(2)(a)19. To an organ procurement organization by a hospital pursuant to s. 157.06 (5) (b) 1.

146.82(2)(b) Except as provided in s. 610.70 (3) and (5), unless authorized by a court of record, the recipient of any information under par. (a) shall keep the information confidential and may not disclose identifying information about the patient whose patient health care records are released.

146.82(2)(c) Notwithstanding sub. (1), patient health care records shall be released to appropriate examiners and facilities in accordance with ss. 971.17 (2) (e), (4) (c) and (7) (c), 980.03 (4) and 980.08 (3). The recipient of any information from the records shall keep the information confidential except as necessary to comply with s. 971.17 or ch. 980.

146.82(2)(d) For each release of patient health care records under this subsection, the health care provider shall record the name of the person or agency to which the records were released, the date and time of the release and the identification of the records released.

Reports made without informed consent.

146.82(3)(a)Notwithstanding sub. (1), a physician who treats a patient whose physical or mental condition in the physician’s judgment affects the patient’s ability to exercise reasonable and ordinary control over a motor vehicle may report the patient’s name and other information relevant to the condition to the department of transportation without the informed consent of the patient.

146.82(3)(b) Notwithstanding sub. (1), an optometrist who examines a patient whose vision in the optometrist’s judgment affects the patient’s ability to exercise reasonable and ordinary control over a motor vehicle may report the patient’s name and other information relevant to the condition to the department of transportation without the informed consent of the patient.

146.82(3)(c) For each release of patient health care records under this subsection, the health care provider shall record the name of the person or agency to which the records were released, the date and time of the release and the identification of the records released.

Access to patient health care records.

146.83(1) Except as provided in s. 51.30 or 146.82 (2), any patient or other person may, upon submitting a statement of informed consent:

146.83(1)(a) Inspect the health care records of a health care provider pertaining to that patient at any time during regular business hours, upon reasonable notice.

146.83(1)(b) Receive a copy of the patient’s health care records upon payment of reasonable costs.

146.83(1)(c) Receive a copy of the health care provider’s X-ray reports or have the X-rays referred to another health care provider of the patient’s choice upon payment of reasonable costs.

146.83(1m)(a) A patient’s health care records shall be provided to the patient’s health care provider upon request and, except as provided in s. 146.82 (2), with a statement of informed consent.

146.83(1m)(b) The health care provider under par. (a) may be charged reasonable costs for the provision of the patient’s health care records.

146.83(2) The health care provider shall provide each patient with a statement paraphrasing the provisions of this section either upon admission to an inpatient health care facility, as defined in s. 50.135 (1), or upon the first provision of services by the health care provider.

146.83(3) The health care provider shall note the time and date of each request by a patient or person authorized by the patient to inspect the patient’s health care records, the name of the inspecting person, the time and date of inspection and identify the records released for inspection.

146.83(4) No person may do any of the following:

146.83(4)(a) Intentionally falsify a patient health care record.

146.83(4)(b) Conceal or withhold a patient health care record with intent to prevent or obstruct an investigation or prosecution or with intent to prevent its release to the patient, to his or her guardian appointed under ch. 880, to his or her health care provider with a statement of informed consent, or under the conditions specified in s. 146.82 (2), or to a person with a statement of informed consent.

146.83(4)(c) Intentionally destroy or damage records in order to prevent or obstruct an investigation or prosecution.