Privacy, Quality and Safety

Notice of Privacy Practices

This Notice outlines your rights to the access and release of medical information regarding your care and treatment at Edgerton Hospital and Health Services. This information is provided in accordance with Federal regulations.

Please review our full Notice of Privacy Practices

• English Version
• Spanish Version

Understanding Your Health Records and Information 

A record of your visit is created each time you visit a hospital, physician or other healthcare provider. Typically, these records contain essential information about your care and treatment. They describe the reason for your visit, examination and test results, your medical history, any diagnoses and treatments, your plan of care and the ultimate disposition of your care. All of this information is usually referred to as your “medical records” or “health information.” Your medical record essentially serves as a:

• Basis for planning your care and treatment.
• Means of communication between the multiple health care professionals involved in your care and treatment.
• Legal document describing the care provided and follow-up care needed.
• Source of information required for use by public health officials to assess the effectiveness of providers and health care programs in the State.
• Source of data for the hospital to assess its performance and plan for future service needs.
• Source of data and statistics for use in medical research.

By law, hospitals, physicians and health care providers own the medical records they create and are held responsible for their storage and safekeeping in accordance with applicable State and Federal laws. While you have specific rights to the access and release of information concerning your personal medical records, you do not own them.

Requests for Information and Problem Reporting

To request access to your medical records, or to release your medical records to another individual, please contact our Health Information Management Department at the contact information below.  We may request that you complete our Release of Information Form.

Our Release of Information form can be downloaded here, completed and sent to the Health Information Management Department (see below).

• English Version
• Spanish Version

Edgerton Hospital and Health Services
Health Information Management Department
11101 N. Sherman Road
Edgerton, WI 53534
Phone: 608-884-1628
Fax: 608-884-1626

To submit a request to correct your medical records, please complete the Request for Amendment Form. This form can be Downloaded Here, completed and sent to the Privacy Officer (see contact information below).

For questions regarding privacy of medical records, hospital privacy policies or practices, or any other access/release/correction/privacy concerns, please contact our HIPAA Privacy Officer at:

Edgerton Hospital and Health Services
HIPAA Privacy Officer
11101 N. Sherman Road
Edgerton, WI 53534
608-884-1631

Quality and Safety

Patients’ Rights and Responsibilities

• English version
• Spanish version

To report concerns about patient safety or quality of care, please contact:

Edgerton Hospital and Health Services
Quality Director
11101 N. Sherman Road
Edgerton, WI 53534
608-561-6620 

For unresolved concerns, you may contact:

Wisconsin Department of Health Services
Wisconsin Division of Quality Assurance
PO Box 2969
Madison, WI 53701
608-266-8481

Health Care Worker Safety

Pursuant to Section 940.204 of the Wisconsin Statutes, whoever intentionally causes bodily harm or threatens to cause bodily harm to a health care provider or to a family member of a health care provider can be found GUILTY of a Class H felony, which means a person who harms or threatens to harm a health care provider, or their family member, could be:
• fined up to $10,000, and
• imprisoned for up to 6 years.

AND, if the person causing the injury or making the threat uses a weapon or has prior convictions, the potential imprisonment may be increased by as much as an additional 4 years.