Person to Identify In-Person Telephone Request in Encounter Encounter Writing (Fax, mail, hand-delivered) Attorney Presents with It would be Supplies business business card or difficult to verify card, photo Wisconsin state identity and identification (i.e. bar membership authority by drivers license or and photo phone. organization ID identification (i.e. Verification in badge), letterhead. drivers license or person or in A confirmatory organization ID writing may be phone call badge). required regarding the requester may be required. Verify identity Verify identity Verify identity Facility Directory Patient Patient provides Patient provides Patient provides name, address, name, address, name, address, and date of birth and date of birth and date of birth and/or social and/or social and/or social security number; security number; security number. or or Next verify the Acquainted with Acquainted with patient’s signature patient patient with signature on file or on driver’s license, if available. Personal Personal Personal Personal Representative Representative Representative Representative provides provides provides (Legal Guardian) for patient’s patient’s patient’s the Patient name, address, name, address, name, address, and date of birth and date of birth and date of birth and/or social and/or social and/or social security number, security number, security number. and verifies (via and verifies (via Next verify the appropriate legal appropriate legal personal documentation) documentation) representative’s relationship to relationship to signature with patient; or patient; or signature on file Acquainted with Acquainted with or on driver’s personal personal license, if representative as representative as available. being such being such Persons Involved in Patient actively Patient actively N/A the involves this involves this Patient’s
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
HCR-Identity-Verification-Policy-FINAL-10.30.17.docx