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Administrative (Non-Clinical) Policy
This administrative policy applies to the operations and staff of the University of Wisconsin Hospitals and
Clinics Authority (UWHCA) as integrated effective July 1, 2015, including the legacy operations and
staff of University of Wisconsin Hospital and Clinics (UWHC) and University of Wisconsin Medical
Policy Title: Release of Protected Health Information for Worker’s
Policy Number: 4.10
Effective Date: August 10, 2017
Chapter: Legal Services
To establish a policy to insure compliance with the statutes relating to release of protected health
information ("PHI") for worker's compensation purposes.
II. POLICY ELEMENTS
A. General Rule-No Authorization Required - Upon a written request for PHI by the employee,
employer, worker's compensation insurer or the Department of Workforce Development (DWD)
UW Health may release, without written authorization, PHI that is reasonably related to the date
of injury (or date first treated when date of injury is unknown) and type of injury for which the
employee claims compensation. Mental health records may only be released if directly related to
the claim or injury.
B. When Written Authorization is/may be Required - PHI needed for worker's compensation
purposes but relating to the primary treatment of drug or alcohol abuse cannot be released without
the written authorization of the patient. PHI relating to the primary treatment of AIDS or HIV
testing may be released without patient consent after consultation with the Director or Assistant
Director of Health Information Management (HIM) to confirm that the information is reasonably
related to an injury for which compensation is being claimed. Additionally, a written
authorization is required to release records above and beyond what is reasonably related to the
C. Verification Requirements - Prior to making any disclosure of PHI for worker's compensation
purposes, staff must take measures to verify the identity and authority of the person /organization
making the request. Written requests by employer, worker's compensation insurer or the
Department of Workforce Development (DWD) must be made on organizational letterhead as
proof of identity and authority of person to make the request. If the relationship between the
representing individual or agency and the patient, employer, worker's compensation insurer or
DWD is not clear, request proof or verification of authority to represent.
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D. PHI may not be released in response to verbal requests for PHI by the employee, employer,
worker's compensation insurer or the Department of Workforce Development (DWD). Such
requests must always be in writing.
Protected Health Information - Individually identifiable health information that is transmitted or
maintained in any form, including oral, written, or electronic. Protected health information includes
demographic, health, and financial information.
IV. FORMS USED
Authorization For Disclosure of Protected Health Information (UWH# 1280490-DT)
A. Written Requests for PHI.
1. Upon receipt of a written request for medical information regarding a worker's
compensation claim, the following must be verified:
a. The request is from the employee, employer, worker's compensation insurer or
b. The nature of the claim and accident date is specified.
2. If the written request is not valid or incomplete, is returned to requesting party to request
a copy of the claim or an authorization.
3. Requests for release of information should be forwarded to the Health Information
Management Department to ensure that only information related to the work comp claim
or injury is released. If the record involves primary treatment of drug or alcohol abuse,
the request will be rejected indicating that an authorization signed by the patient is
required. Records relating to the primary treatment of AIDS or HIV testing may be
released without patient consent after consultation with the Director or Assistant Director
of HIM to confirm that the information is reasonably related to an injury for which
compensation is being claimed.
a. A copy of the claim should be requested if the file is complex and it is difficult to
determine which information is related to the claim.
b. If an individual or agency representing either the employer or worker's
compensation insurer requests preexisting condition or questionable information,
an authorization signed by the patient is required.
4. When allowing attorneys or insurance representatives to view the patient's paper and/or
electronic medical record, only the information that is reasonably related to a work
injury/accident is made available for the requester. Viewing of the UW Health medical
record must be scheduled with Health Information Management during normal business
hours of 8 am to 4 pm, Monday through Friday (excluding holidays) at 608-263-6030,
Option 3 or by coming to HIM at 8501 Excelsior Drive. Appointments for viewing will
be made with a minimum of 24 hours’ notice.
a. When more than those records specific to the work comp claim or injury is
requested, a patient authorization must accompany the request.
b. All records not related to the work related injury should not be available to the
5. UW Health staff will account for the disclosure by documenting on the request what was
released, the date of the release, and the name of the person who performed the release.
The written request is scanned into the EHR.
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6. UW Health Work Comp staff may access only Employee Health records that are
reasonably related to an employee’s work injury.
Sr. Management Sponsor: SVP, General Counsel
Author: Director, Health Information Management
Approval committee: UW Health Administrative Policy & Procedure Committee
UW Health Chief Administrative Officer