Effective: September 23, 2013




The Wisconsin State Laboratory of Hygiene (WSLH) is committed to protecting your health information within Federal and State regulations. This notice will explain to you ways we may use and disclose health information about you, and your rights as a patient in regard to that information. We are required by law to adhere to the terms of this or any similar updated notice.


Uses and Disclosures of Your Protected Health Information (PHI)


We may use and disclose your PHI for the purposes of Treatment, Payment, and Healthcare Operations (TPO) without your authorization. Examples of these occurrences are:

Treatment—Information may be shared to determine appropriate medical treatment, such as the use of laboratory test results by clinicians to diagnose an illness.

Payment—Medical information may be shared with third-party payers to ensure proper payment for your laboratory test. Examples of third-party payers are Medicaid, private insurance, and Medicare.

Healthcare Operations—Information may be shared to comply with regulations, such as Medicare Compliance auditors.

WSLH is required to notify you following a breach of your unsecured PHI that compromises the security or privacy of the PHI.


Uses and Disclosures for Public Health Activities


The WSLH is designated by statute to be the public health laboratory for the State of Wisconsin. As such it has unique responsibilities for supporting the efforts of local, state and federal public health agencies to protect the health of all. PHI may be used by the WSLH and/or disclosed to other public health entities or legal authorities without your authorization when it is used to prevent or control disease, injury or disability or for other health oversight activities. Examples include: (a) reporting test results that may indicate a food or communicable disease outbreak; (b) providing data for local health departments to investigate potential health problem such as may occur in a day care center or nursing home; (c) alerting public health officials of unusual test results that may be an indicator of an emerging disease in our state such as hantavirus or West Nile virus; (d) conducting epidemiological investigations to determine the effectiveness of one laboratory procedure compared with another.

There are several other circumstances, often under the requirement of law, where we may disclose your PHI without obtaining your authorization.  These include:


Disclosures Required by Law—Your health information may be disclosed when required to do so by Federal or State laws.

Victims of Abuse, Neglect, or Domestic Violence—WSLH is required by law to report any suspected abuse of a child, and is permitted to report suspected abuse of an adult.

Health Oversight Activities—We may be required to disclose information in the course of audits, inspections, investigations, and other similar activities.

Judicial and Administrative Proceedings—Information may be required from us in legal proceedings.  

Law Enforcement Purposes—We must comply with any court orders issued under State and Federal law.           

Coroners, Medical Examiners, and Funeral Directors—We must provide information as needed in death investigations.

Organ Donation Purposes—We must provide information to authorized facilities for organ donation and transplants.

Military and Veterans Purposes—We may be required to report medical information to military command or the Veteran’s Administration.

Research Purposes—WSLH may use and disclose your health information for research purposes, which may include contacting you about participation in research projects. A research review board exists to protect the rights of all research participants, including their privacy and confidentiality rights.

To Avert a Serious Health or Safety Threat—We may be required to provide information to protect the health and safety of you, another person, or the public.

Specialized Government Functions—We must comply with laws regarding national security, protective services of the President, and correctional institutions.

Workers’ Compensation—We must provide information requested for work-related Illness/injury benefits.


Uses and disclosures of your health information that you may object to or refuse:

Disaster Relief Efforts—Unless you object, WSLH may provide information to assist in locating, identifying, or describing the health of disaster victims.

Personal Representatives—Unless you object, WSLH may provide information to family members or someone assisting with patient care or payment of patient care. If we are unable to determine if you agree or object to the sharing of your health information because you are not present or are incapacitated, or there is an emergency circumstance, we may provide your health information to family members or others involved in your care if, in our professional judgment, this would be in your best interests.


Uses and disclosures of your health information requiring your authorization:

WSLH must first obtain your written authorization in order to use or disclose your health information for marketing purposes or if we seek to sell your health information. In addition, to use or disclose your health information for any purpose not listed above, WSLH must first obtain your written authorization. Even if you authorize the use or disclosure for a particular purpose, you may revoke your authorization. To do this, you must submit a request in writing to withdraw the authorization. We will comply with your request if it is received before we have disclosed the information.


Patient Rights


You have the right to:


  • Request Restrictions—You may submit a request in writing to place restrictions or limitations on certain uses and disclosures of your PHI. Except in limited situations, WSLH must agree, in most cases, if you request a restriction of disclosure of your health information to your health plan related to services or items for which you have paid WSLH in full. If you qualify as a Wisconsin Family Planning Contract patient, your medical information will be disclosed to your insurance company only if you sign the billing authorization on the laboratory test request form. For all other patients, as noted above, medical information will be submitted for payment to appropriate payers.
  • Inspect and Receive Copies of Your Health Information—You may submit a request in writing to the WSLH Privacy Officer to examine your PHI. All pertinent information will be made available, with some exceptions such as for data compiled for civil, criminal or other legal proceedings. A fee may be charged for the costs of copying and mailing the information requested and producing an electronic copy. WSLH reserves the right to deny your request. However, if you are denied access to your medical information, you may request that the denial be reviewed. A different party will review the denial, and we will comply with the result of the review. You may request an electronic copy of your health information and, if WSLH maintains the information you have requested in electronic form, we will provide it to you in a form and format agreed to by you and WSLH.
  • Request Confidential Communications—You may also submit a request in writing to receive your health information by alternative methods. WSLH has the right to determine if the request is reasonable. Examples are to have information requested by you delivered to you at a location specified by you, or called to you at a specific phone number.
  • Amend Your PHI—You have the right to submit a request in writing for amendment/correction of your PHI if you determine that it is inaccurate or incomplete. WSLH reserves the right to deny your request if you do not include a reason for the request, if we conclude that the current information is accurate and complete, and/or if the information in question was not created by WSLH. To change information not created at WSLH, you will need to contact the source of the information (generally your clinic) to request an amendment. Your clinic will then submit a written request to us to amend our record.
  • Accounting of Information Released—You may submit a request in writing to receive an accounting of disclosures of your information made by WSLH for a period up to six years before the date of your request, but not before April 14, 2003 (HIPAA Privacy Regulation Effective Date).
  • Receive a Paper Copy of This Notice upon your request by calling 608-262-1293 or writing to the address below.


File a Complaint


If you feel your privacy rights have been violated, you may contact the Secretary, Department of Health and Human Services (DHHS) by any of these methods:

  • Writing a letter to:
    Region V
    Office for Civil Rights
    U.S. Dept. of Health & Human Services
    233 N. Michigan Ave., Ste. 240
    Chicago, IL 60601

OR via fax at: 312-886-1907


  • Email:
  • Voice phone: 312-886-2359; TDD 312-353-5693

You should also provide a copy of the letter or other written notification of your concerns to the WSLH and the University of Wisconsin-Madison to the address below. You will not be penalized in any way for filing a complaint.

HIPAA Privacy Officer
University of Wisconsin-Madison
Office of the Provost
Bascom Hall, Rm.150
500 Lincoln Drive
Madison, WI 53706-1380.


Administrative Information


Written requests for information in the “Patient Rights” portion mentioned above may be mailed or faxed to the appropriate department that received your specimen. If you are faxing your request, please call to obtain the correct fax number and arrange for the confidential receipt of your request.

If you have questions about this Notice, please feel free to contact us at:

Wisconsin State Laboratory of Hygiene
Errin Rider, PhD, D(ABMM)
HIPAA Privacy Coordinator
465 Henry Mall, Room 235A
Madison WI 53706


We reserve the right to revise the Notice of Privacy Practices. Our website will announce any changes made to this document and the effective dates of such changes.


UW Policy #: 2


Revised by WSLH HIPAA Privacy Coordinator: September, 2013