Person to Identify In-Person Encounter Telephone Encounter Request in Writing (Fax, mail, hand-delivered) Attorney Presents with business card or Wisconsin state bar membership and photo identification (i.e. drivers license or organization ID badge). It would be difficult to verify identity and authority by phone. Verification in person or in writing may be required Supplies business card, photo identification (i.e. drivers license or organization ID badge), letterhead. A confirmatory phone call regarding the requester may be required. Facility Directory Verify identity Verify identity Verify identity Patient Patient provides name, address, and date of birth and/or social security number; or Acquainted with patient Patient provides name, address, and date of birth and/or social security number; or Acquainted with patient Patient provides name, address, and date of birth and/or social security number. Next verify the patient’s signature with signature on file or on driver’s license, if available. Personal Representative (Legal Guardian) for the Patient Personal Representative provides patient’s name, address, and date of birth and/or social security number, and verifies (via appropriate legal documentation) relationship to patient; or Acquainted with personal representative as being such Personal Representative provides patient’s name, address, and date of birth and/or social security number, and verifies (via appropriate legal documentation) relationship to patient; or Acquainted with personal representative as being such Personal Representative provides patient’s name, address, and date of birth and/or social security number. Next verify the personal representative’s signature with signature on file or on driver’s license, if available. Persons Involved in the Patient’s Patient actively involves this Patient actively involves this N/A
Immediate Care (PHI relevant only to the patient’s current care (164.510(b)) Blood Relative Spouse Domestic Partner Roommate Boy/Girl Friend Neighbor Colleague Foster Parent Operator of Juvenile Group Home person in his/her care. person in his/her care. Power of Attorney For the Patient Presents with a photo ID and a copy of the POA. Verify the patient’s signature with one on file, if available. Previously obtained a copy of the POA and verified the patient’s signature with one on file, if available. Obtain a copy of the POA and verify the patient’s signature with one on file, if available. Provider From Another Facility Acquainted with provider as a treatment provider; Provider is wearing a photo badge from his/her facility; or Patient/personal representative introduces provider to you. Acquainted with provider as a treatment provider; or Call the requestor back through the main switchboard number at that facility (instead of through the direct number) Recognize name of facility and address on letterhead as a treatment facility; or Call the requestor through the main switchboard number at that facility (instead of through the direct number). Public Official CIA Court Order FBI Law Enforcement Officer Must verify identity through: Presents an agency identification badge; Cannot verify via telephone Must verify identity through: Request on appropriate government letterhead or a