Privacy & Confidentiality
These documents explain how ThedaCare protects your personal and health information and how that information may be used or shared.
Joint Notice of Privacy Practices
This notice explains how your health information may be used and disclosed, and describes your rights under the Health Insurance Portability and Accountability Act (HIPAA). It applies to all participating ThedaCare entities and replaces separate HIPAA notices. The notice is available in multiple languages.
Joint Notice of Privacy Practices – full details
Joint Notice of Privacy Practices (English PDF)
Consent for the Use and Disclosure of Substance Use Disorder (SUD) Records
This form lets you authorize ThedaCare to share your SUD treatment records with others you choose. Your information is protected, and you can revoke this consent at any time. The consent is available in multiple languages.
Consent for the Use and Disclosure of Substance Use Disorder (SUD) Record (English PDF)
Consent for the Use and Disclosure of Substance Use Disorder (SUD) Record (Español PDF)
Consent for the Use and Disclosure of Substance Use Disorder (SUD) Record (Hmong PDF)
Online Privacy Statement
This statement explains how ThedaCare collects, uses, and protects information when you visit our website or use our online services. We value our relationship with you and we work hard to keep your medical information confidential. Learn more about how we safeguard your online information.
Patient Rights & Responsibilities
These documents outline your rights as a patient and what you can expect from ThedaCare.
Patient’s Rights and Responsibilities
Understanding your rights regarding care, communication, privacy, and decision-making is important. For your convenience, we have provided ThedaCare’s Patient’s Rights and Responsibilities in multiple languages.
Patient Rights and Responsibilities (English PDF)
Patient Agreement and Consent to Care
This form confirms that you agree to receive medical care from ThedaCare and understand your rights, responsibilities, and the care process. It is available in English, Hmong, and Spanish.
Patient Agreement and Consent to Care (English PDF)
Power of Attorney for Health Care (POA-HC) / Advance Directives
Learn about advance care planning, including living wills and health care powers of attorney, and access related forms and instructions to help ensure your health care wishes are known if you are unable to make decisions for yourself.
Medical Records & Authorizations
Use these forms to request or authorize access to medical records.
Authorization for Release of Information
These forms allow ThedaCare to transfer your medical records to another provider or provide medical treatment to your child in your absence.
For more information on medical records, please call our Health Information Department at 920-729-2164.
Form Completion Request
A Form Completion Request asks you to fill out and return a specific form. These requests may include instructions, require signatures or authorization, and are used for administrative or medical purposes such as insurance, FMLA, or other healthcare needs. Completing all sections of the form helps avoid delays in processing.
Request for Medical Records
ThedaCare now offers an Online Medical Record Request tool for the following individuals to request patient records:
- Patients requesting their own records
- Parents of minor patients requesting records
- Caregivers acting on behalf of a patient (i.e. Power of Attorney)
The online tool verifies your identity by asking for a photo of your driver’s license, which can be taken via webcam or smartphone. There is no additional charge to use this service.
Recommended browsers: Chrome, Safari, or Firefox If you experience issues, please call 920-454-5538.
Request to Make a Change or Amendment to Your Medical Record
To request an amendment of or correction to your health information as permitted by HIPAA, download and complete all fields on this form and email it to comphotl@froedtert.com.
Request for an Accounting of Disclosures
To request an accounting of the disclosures of your records as permitted by HIPAA, download and complete all fields on this form and email it to comphotl@froedtert.com.
Financial & Billing Information
Information related to pricing transparency, billing, and financial policies.
Standard Hospital Charges
The federal government requires hospitals to post standard charges for inpatient and outpatient services.
Payment Options
If you’ve received a bill from ThedaCare, payment options are available. We provide care regardless of ability to pay and can help identify a solution that works for you.
Financial Assistance (Caring Hearts Program)
ThedaCare offers financial assistance for eligible patients who cannot pay for medically necessary care. Discounts or bill reductions are based on income and family size.
Policy & Forms: Available in English, Spanish, and Hmong, including the full policy, plain-language summary, and application form.
Cost Estimate Tool
Use the Cost Estimate Tool for a price estimate on over 300 services with standard prices to better understand healthcare services and cost of care. Search procedures and services here.
For questions about estimates, payment plans, or financial assistance, please call 800-236-4102.
Website & Digital Services Policies
These policies govern use of ThedaCare’s website and digital health services.
Telehealth / Virtual Care Terms
These terms apply to ThedaCare’s Virtual Health Services, including Video Visits and eVisits, which may involve communication via video, audio, messaging, email, or mobile devices.
Mobile Texting (SMS/MMS)
Terms and conditions for Froedtert ThedaCare mobile text messaging.
Diversity
ThedaCare values the unique characteristics, experiences, and perspectives of the communities we serve.
