Policies and Legal Forms

Online Privacy Statement

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.

Privacy Practices (HIPAA)

Your health information is protected by strict guidelines. There are instances when we need to release this information to a third party. You can find out more in our Privacy Practices in English, Spanish, and Hmong.

Patient's Rights and Responsiblities

Understanding your patient rights and responsibilties is important to everyone. For your convenience we have provided ThedaCare's Patient's Rights and Responsibilities in EnglishSpanish and Hmong.

 

Charity Care

ThedaCare provides healthcare services to everyone regardless of their ability to pay. Find out more about our Charity Care services or download a Caring Hearts application.

Diversity

ThedaCare values the unique characteristics, experiences and perspectives of the people that live in our communities. Find out more about how we embrace our diverse communities.

Payment for Service

We want you to have a clear understanding of payment expectations. Learn more about our Payment for Service policy.

Advance Directives/Power of Attorney for Healthcare

Sometimes others must help you make your healthcare decisions. For your convenience, we’ve provided the needed forms and instructions.

Health Release Forms

These forms allow ThedaCare to transfer your medical records to another provider or give medical treatment to your child in your absence. Find out more. For more information on medical records, please call our Health Information department at 920-738-6525.

Access to Online Medical Records

To access online medical records through MyThedacare, please complete an Authorization Form.  You may download the Authorization Form for proxy to a child's account or the Authorization Form for proxy to an adult's account.

ThedaCare Behavioral Health forms

For your convenience the Client Information Form and the Client Insurance Form are available for you. You can print and fill out the insurance information and patient information forms before your appointment and bring them along to your visit.