SeniorCare Notice of Privacy Practices

Privacy Notice and Forms

  • SeniorCare Notice of Privacy Practices (EnglishHmongLaotian [PDF, 312KB], RussianSpanish)
  • Wisconsin SeniorCare HIPAA Privacy Authorization for Use or Disclosure — F-3161 (PDF 109 KB)
  • Wisconsin SeniorCare HIPAA Privacy Access Request — F-13162 (PDF 100 KB)
  • Wisconsin SeniorCare HIPAA Privacy Accounting Request — F-13163 (PDF 92 KB)
  • Wisconsin SeniorCare HIPAA Privacy Alternate Communication Request — F-13164 (PDF 96 KB)
  • Wisconsin SeniorCare HIPAA Privacy Amendment Request — F-13165 (PDF 88 KB)
  • Wisconsin SeniorCare HIPAA Privacy Complaint — F-13166 (PDF 92 KB)
  • Wisconsin SeniorCare HIPAA Privacy Revocation of Authorization — F-13167 (PDF 96 KB)
  • Wisconsin SeniorCare HIPAA Privacy Restriction Request — F-13168 (PDF 88 KB)
  • SeniorCare Authorization of Representative — F-10080 (PDF 72 KB)

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Last Revised: February 10, 2015