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Health and Human Services Health and Human Services Main Page
DAIM NTAWV QHIA TXOG KEV SIV KOJ COV NTAUB NTAWV KHO MOB
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shebco logo gif Sheboygan County Health & Human Services Department
1011 North 8th Street, Sheboygan, WI 53081
DAIM NTAWV QHIA TXOG KEV SIV KOJ COV NTAUB NTAWV KHO MOB
DAIM NTAWV NO YUAV QHIA TXOG TIAS KOJ COV NTAUB NTAWV KHO MOB YUAV RAUG SIV MUS LI CAS, YUAV MUAB QHIA RAU LWM TUS LI CAS THIAB YUAV UA LI CAS KOJ THIAJ SAIB TAU KOJ COV NTAUB NTAWV NO.
THOV UA TIB ZOO NYEEM DAIM NTAWV NO.

Sheboygan County Health and Human Services Department paub tias yuav tsum siv sij hawm los mus qhia rau ib tug neeg mob txog nws tej ntaub ntawv kho mob uas yuav siv thiab muab qhia rau lwm tus mas yog tus neeg ntawd txoj cai thiab yog lub Department txoj hauj lwm raws kev cai lij choj ceev txog tej ntaub ntawv no.

SHEBOYGAN COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT YUAV SIV THIAB QHIA RAU LWM TUS TXOG KOJ TEJ NTAUB NTAWV KHO MOB LI CAS:

Peb qhov chaw ua hauj lwm siv koj tej ntaub ntawv kho mob uas tau ceev cia los mus pab kho koj tus mob, npaj ntsuam xyuas txog kev them nqi kho mob thiab nrhiav kev los pab txog txoj kev kho mob:
1. KEV KHO (Treatment): Peb kuj yuav muab koj tej ntaub ntawv kho mob no qhia rau tus kws kho mob los yog lwm qhov chaw ua hauj lwm kho mob. Txhua yam kev kho mob uas sau rau hauv koj tej ntaub ntawv lawm mas lwm tus kws kho mob(doctors and therapists), cov kws tu mob (nurses), los yog ,cov neeg ua hauj lwm (case workers) kuj yuav tau pom. Piv txwv tias, cov neeg ua hauj lwm (case managers) pab koj kuj yuav tau saib tej ntaub ntawv kho koj no los npaj nrhiav kev pab rau koj. Yog koj raug kho nyob rau hauv txoj cai kho mob( Chapter 51- mob hlwb, ruam, los yog, siv tshuaj, dej cawv), mas cov neeg hauv lub tsev ua hauj lwm no xwb thiaj muaj cai saib tau koj cov ntaub ntawv tsis tas yuav tau kev tso cai los ntawm koj.
2. THEM NQI (Payment): Kuj yuav muab koj tej ntaub ntawv kho mob xa mus rau qhov chaw pab them nqi (Medical Assistance) hauv xeev Wisconsin, los yog, lwm qhov chaw them nuj nqi kho mob. Thaum muaj li no lawm, koj cov ntaub ntawv kho mob kuj yuav tau muab qhia txawm tsawg los kom tsim nyog lawv paub txaus rau kev them nuj nqis xwb. Xwsli, qhia txog tias koj yog leej twg, koj tus mob yog dab tsi, thiab kho koj li cas lawm. Nyob hauv txoj cai kho mob (Chapter 51) thiab kev kho tus kab mob HIV mas koj yuav tsum tso cai thiaj yuav muab tau koj tej ntaub ntawv qhia rau lwm tus.
3. QHOV CHAW KHO MOB TES HAUJ LWM (Health Care Operations): Qhov chaw ua hauj lwm no kuj yuav xyuas koj tej ntaub ntawv los soj ntsuam txog txoj kev ua hauj lwm. Txoj kev soj ntsuam tej ntaub ntawv uas cov kws kho mob (doctors and therapists),cov kws tu mob(nurses), cov neeg ua hauj lwm (caseworkers), thiab lwm cov kws kho mob tau kho koj mas kuj yuav tau muab piv rau lwm tus neeg muaj mob ib yam li koj saib tej dej num lawv ua puas yuav muaj nuj qhis pab tau koj li cas.
4. KEV TXUAS LUS THIAB SIB QHIA TXOG KOJ TEJ NTAUB NTAWV: Yuav muab koj tej ntaub ntawv coj los soj ntsuam dua yog thaum txog caij nyoog yuav rov ntshuam xyuas saib yuav pab koj li cas ntxiv, los yog, yuav rov ntsib koj dua. Ua li no mas, peb kuj yuav tau rov nrog koj txuas lus teem caij nyoog sib ntsib, los yog, ho qhia rau koj paub txog lwm txoj kev pab uas koj xav tau.

Tseem Fwv txoj cai lij choj kuj muaj txoj cai hais tias qhov chaw ua hauj lwm no muaj cai tsis tas tau kev tso cai ntawm koj thaum yuav muab koj tej ntaub ntawv kho mob uas txwv tsis pub qhia tawm hauv no rau lwm tus yog yuav:
1. Kom Ua raws li, losyog, tau kev tso cai los ntawm txoj cai lij choj (As require or permitted by law): Yog hais tias ib yam ntawm koj tej ntaub ntawv kho mob muaj cuam tshuam mus txog rau kev plaub ntug, hauv tsev hais plaub, los yog hauv txoj kev tsw j hwm khiav hauj lwm. Xwsli, peb yuav tsum tau hais qhia txog cov kev raug tsim txom, tsis saib xyuas, los yog, lwm yam kev raug mob ntawm cev nqaij daim tawv, los yog, teb mus rawsli tsev hais plaub txiav txim tuaj.
2. Tiv thaiv Pej Xeem Kev Noj Qab Haus Huv (For public health reasons): Ua raws txoj cai lij choj, peb kuj yuav muab koj cov ntaub ntawv kho mob rau tseem fwv qhov chaw saib xyuas pej xeem kev noj qab hauv huv los yog tseem fwv coj cai uas muaj cai yuav los tiv thaiv tej kab mob kom txhob sib kis tau, los yog cheem kev raug mob , los yog, kev puas tsuaj (disability).
3. Soj ntsuam txog kev noj qab haus huv tej hauj lwm (Health oversight activities): Kuj yuav tau muab koj tej ntaub ntawv rau tseem fwv saib xyuas kev tswj chaw kho mob nkeeg . Piv xam li yuav soj ntsuam txog daim ntawv tso cai khiav hauj lwm (licensing) thiab soj ntsuam cov chaw kho mob, tshuaj xyuas(audits) tej ntaub ntawv kho mob, los yog, lwm yam kev soj ntsuam txog tej chaw kho mob nkeeg.
4. Siv Ntaub NtawvTeev KevTuag (Death Records): Ntaub ntawv hais txog kev tuag tau muab sau cia thiab khaws cia rau hauv tseem fwv tej qhov chaw ua hauj lwm xws li: Qhov chaw Zwm Ntaub Ntawv pov thawj (Register of Deeds), Tus neeg tuav kev qhia txog neeg txoj sia tu(coroner), thiab tus kws tshawb xyuas txog vim li cas neeg tuag(medical examiner)
5. Muab ib yam hauv lub cev pub rau lwm tus (Organ donor): Yog txaus siab muab ib yam ntawm lub cev nqaij daim tawv pub rau lwm tus mas cov ntaub ntawv ntawd kuj yuav tsum tau muab qhia tawm kom thiaj paub nrhiav tus neeg haum siv qhov nqaij ntawd rau.
6. Tshawb txuj (Research): Nyob ntawm qee yam, thiab tom qab uas tau kev tso cai tshwj xeeb tas lawm, mas kuj yuav siv tej ntaub ntawv los pab rau kev tshawb txuj.
7. Tiv Thaiv Kev puas tsuaj rau kev noj qab haus huv thiab kev nyob nyab xeeb (Health and Safety Threat): Tej ntaub ntawv yuav muab qhia tawm kom zam tau, los yog, txo qhov yuav ua rau koj tus mob loj tuaj, losyog, kev muaj xwv txheej rau koj lub cev, mus rau lwm tus, losyog rau tsoom pej xeem.
8. Qhia Rau Tseem Fwv Tes Hauj lwm Tshwjxeeb/Tswj Txoj Cai(Specialized Government Functions/Law Enforcement): Kuj yuav siv koj cov ntaub ntawv,los yog, qhia rau Tseem Fwv tej hauj lwm tseem ceeb xws li:yuav tau muab koj cov ntaub ntawv qhia rau Tseem Fwv kev tuav tub rog yog tam sim no koj yog ib tug tub rog, los yog, koj tau ua tub rog rau Tseem Fwv As Mes Lis Kas yav tas los lawm. Yog cov chaw ua haujlwm tswj txoj cai xav tau tej ntaub ntawv no mas kuj yuav muab rau lawv thiab. Piv tswv tias, yog koj raug ntes tswj cias hauv tub tswj cai lub xib teg lawm, losyog, koj yog ib tug raug kaw rau hauv tsev loj faj (Correctional Institution) mas koj cov ntaub ntawv kuj yuav raug muab coj los siv.
9. Them Nyiaj raug mob rau tus neeg ua hauj lwm (Worker's compensation): Tej Ntaub ntawv kho mob kuj yuav raug muab qhia raws li txoj cai, yog cuam tshuam nrog kev them nyiaj raug mob rau tus neeg ua hauj lwm txoj cai kev pab, los yog, lwm txoj kev pab rau kev raug mob los ntawm txoj haujlwm, los yog ua mob.
10. Cawm Ntawm Kev Puas Tsuaj (Disaster Relief): Cov ntaub ntawv kuj yuav raug muab qhia rau cov chaw ua hauj lwm pab cawm thaum muaj kev puas tsuaj raug koj, lawv thiaj paub qhia koj tsev neeg hais tias koj nyob li cas thiab nyob qhov twg.
11. Koom Nrog Cov Neeg Tu Koj losyog Cov Neeg them nyiaj tu koj(To those involved in your care or payment for your care):Kuj yuav tau muab cov ntaub ntawv no qhia rau koj tsev neeg thiab cov tib neeg uas muaj cai ua tes hauj lwm tu koj.
12. Muab Rau Cov Neeg Koom Hauj Lwm Ua Ke (Business Associates): Muaj qee yam haujlwm kev pab hauv peb qhov chaw ua haujlwm no yog los ntawm ntiav cov neeg ua haujlwm(Business associates) tuaj ua, losyog, cov chaw muab kev pab (service providers) tuaj. Thaum cov kev pab no raug ntiav neeg tuaj lawm, peb kuj yuav qhia koj tej ntaub ntawv kho mob no rau peb cov neeg raug ntiav tuaj ntawd kom lawv thiaj ua tau tes hauj lwm li peb tau kom lawv ua.Txawm li ntawd los, peb yuav kom cov raug ntiav tuaj ua hauj lwm ntawd pab ceev txog koj tej ntaub ntawv uas tau qhia rau lawv kom zoo.
13. Hais Txog Txoj Cai (Statutory Exceptions): Wisconsin Statutes 51.30 and 252.
Txoj cai no kuj muab cai rau koj tias yog tsis tau kev tso cai ntawm koj mas lawv tsuas muab tau koj tej ntaub ntawv tsawg kawg nkaus qhia tawm xwb.
Qhov chaw ua haujlwm kuj yuav siv losyog qhia koj tej ntaub ntawv hais txog kho mob rau lwm tus tau tsuas yog los ntawm kev koj tso cai nkaus xwb, tshwj cov uas hais tas ua ntej saud. Yog tias koj tso cai lawm, koj muaj cai thim koj qhov kev tso cai ntawd rov qab txhua lub sijhawm tsuas yog koj yuav tsum tau sau ntawv qhia rau peb paub, tshwj qhov uas peb twb muab qhia tas raws li koj tau tso cai ntawd lawm.
KOJ TSIS TAS YUAV SUAM NPE RAU DAIM NTAWV TSO CAI ES KOJ THIAJ TAU KEV PAB.

Cov Ntaub Ntawv Hais Txog Kev Kho Mob (Health Information: yog hais txog txhua yam ntaub ntawv tsis hais kev hais lus losyog kaw lus, yam uas tau txais lwm qhov los, losyog, peb tsim hauv no, uas yog –(1) tsim, losyog, tau txais los ntawm cov kws kho mob, tej chaw saib txog kev pab them nqi kho mob, tseem fwv saib xyuas txog pej xeem kev noj qab haus huv, tswv hauj lwm, cov tswv muag kev pov hwm txoj sia, tsev kawm ntawv, losyog, tsev kawm ntawv qib siab, losyog, qhov chaw sawv cev nruab nrab ntawm kev saib xyuas txog kev noj qab haus huv; thiab (2) hais txog Kev noj qab nyob zoo ntawm lub cev nqaij tawv, losyog, ntawm lub hlwb ntawm ib tug neeg tsis hais yav tas los lawm, tamsis no, losyog yav tom ntej; kev kho mob rau ib tug tib neeg; losyog, kev them nqi rau kev tu mob rau tus neeg ntawd tsis hais yav tas los, tamsis no, losyog yav tom ntej.

KOJ TXOJ CAI RAU TEJ NTAUB NTAWV KHO MOB:

SAIB/XYUAS (ACCESS): Koj muaj cai xyuas thiab kom luam koj cov ntaub ntawv hais txog kev kho mob tau, thiab cov ntaub ntawv them nuj nqi (billing record). Peb tsuas yuav tus nqi luam cov ntawv xwb. Tej ntaub ntawv sau tseg hais txog kev kho mob ntawm sab hlwb kev xav (Psychotherapy) uas sau coj los npaj rau kev hais plaub ntug mas yuav muab luam tsis tau.
MUAB QHIA (DISCLOSURES): Txij li lub 4 hlis tim 14, xyoo 2003 no mus, tsis tas yuav tau kev sau ntawv tso cai ntawm koj, peb qhov chaw ua hauj lwm yuav tsum khaws tej ntaub ntawv qhia hais txog tias peb muab koj cov ntaub ntawv no qhia rau leej twg lawm. Koj muaj cai saib cov ntaub ntawv khaws tseg tias peb tau muab koj cov ntauv ntawv qhia rau leej twg lawm. Koj sau tau ntawv thov saib cov ntaub ntawv no mus rau Sheboygan County Health and Human Services Department Privacy Officer. Nyob hauv 12 lub hlis twg, thawj daim ntawv peb yuav luam pub koj dawb, yog thov ntau daim tshaj ntawd lawm peb yuav kom koj them tus nqi. Peb yuav sau ntawv qhia rau koj txog tus nqi, koj mam xaiv saib koj yuav thim los yuav hloov kev thov ua ntej peb muab tus nqi rau koj them.
TXAIS IB DAIM NTAWV QHIA (RECEIVE A PAPER COPY OF THIS NOTICE): Thaum koj tau thov txog, los yog, tsis hais lub sij hawm twg, koj muaj cai txais daim ntawm qhia no. Daim ntawv no muaj nyob ntawm txhua qhov chaw txais tos qhua hauv peb cov tsev ua hauj lwm. Koj kuj yuav mus saib tau daim ntawv no hauv Sheboygan County Website.
KEV TXWV (RESTRICTION): Koj muaj cai yuav thov kom muaj kev txwv ntau tshaj ntxiv, peb qhov chaw ua haujlwm kuj tsis tas yuav pom zoo nrog koj kev thov ntawd, tiamsis, yog pom zoo lawm, qhov kev pom zoo ntawd yuav tsum yog sau ntawv coglus cia.
KEV TXUAS LUS TSIS PUB LEEJ TWG PAUB (CONFIDENTIAL COMMUNICATIONS): Koj muaj cai yuav taij kom peb npaj kev txuas lus nrog koj txawv li kev sib tham txhua zaus. Qhov no yuav tsum yog sau ntawv taij thiab yuav tau qhia hais tias yog sib tham li niaj zaus tham mas ntshai cov lus tham ntawd yuav ua kev puas tsuaj rau koj. Yog hais tias koj kev taij tuaj ntawd tsim nyog lawm, thiab koj qhia hais tias lwm txoj kev yuav sib txuas lus ntawd yog li cas, thiab npaj kev yuav them nyiaj rau tus nqi tau lawm ces, koj txoj kev taij tuaj ntawd, yuav muab kom tau rau koj raws li txojcai.
KEV KHO (AMENDMENT): Koj tsis muaj cai yuav kho cov ntaub ntawv qhia txog koj kev kho mob. Koj muaj cai yuav taij kom peb hais kom meej txog koj cov ntaub ntawv kev kho mob los ntawm kev ntxiv lus rau hauv cov ntaub ntawv ntawd. Koj txoj kev taij tuaj ntawd yuav tsum yog kev sau ntawv, thiab yuav tsum qhia hais tias vim li cas koj cov ntaub ntawv thiaj yuav tau muab kho. Peb qhov chaw ua haujlwm muaj cai yuav tsis ua rawsli koj cov lus taij tuaj. Yog peb tsis ua raws li koj cov lus taij tuaj peb yuav sau ntawv qhia rau koj. Koj muaj cai yuav sau ntawv teb hais tias vim li cas koj thiaj tsis pom zoo raws li peb kev txiav txim siab, peb kuj yuav muab koj cov lus thov lo ntxiv rau koj cov ntaub ntawv cia. Yog hais tias peb pom zoo yuav hloov cov ntaub ntawv raws li koj tau taij tuaj ntawd, peb yuav ua txhua yam qhia kom tau rau cov neeg uas muaj npe raws li koj tau kom peb qhia txog cov ntaub ntawv uas koj xav kho.
HAIS KEV TSIS TXAUS SIAB (COMPLAIN PROCESS): Sheboygan County Health and Human Services Department muaj ntaub ntawv hais txog kev tsis txaus siab es yuav ua li cas yog cov ntaub ntawv kho mob uas peb tau ceev cia ho tau muab siv thiab/losyog muab qhia tawm lawm . Yog koj tsis txaus siab no los koj kuj hu xov tooj, sau ntawv, los yog, tuaj ntsib tus neeg ua hauj lwm Privacy Officer ntawm:

Sheboygan County Health and Human Services Department,
1011 North 8th Street,
Sheboygan, WI 53081
(920) 459-6400

los yog

Koj kuj sau ntawv hais kev tsis txaus siab mus rauThe Secretary of the United States Department of Health and Human Services tau. Txawm yog koj sau ntawv mus li ntawd lawm los peb yeej hais tsis tau hais tias peb tsis txaus siab rau koj li.

Sheboygan County muaj cai yuav hloov daim ntawv qhia (notice) no txhua lub sijhawm. Yog thaum twg hloov lawm, Sheboygan County mam muab ib daim kho tshiab lawm rau koj yog koj taij tuaj.

HNUB PIB (EFFECTIVE DATE): Daim ntawv qhia no pib txij thaum lub 4 hlis tim 14, 2003.
Tsab #1: Luam tawm thawj zaug April 2003

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