SeniorCare: Privacy Information and Forms

SeniorCare is our program for Wisconsin residents who are 65 or older. The program helps seniors pay for prescription drugs and vaccines.

The privacy of your medical information is protected under Wisconsin law. In addition, federal law requires health plans, like SeniorCare, to protect your medical information and let you know how it may be used and released to others.

Privacy notice and forms

• Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, F-02340
• SeniorCare Authorization of Representative, F-10080 (PDF)
• SeniorCare Notice of Privacy Practices, P-13041
• Wisconsin SeniorCare HIPAA Privacy Authorization for Use or Disclosure, F-13161 (PDF)
• Wisconsin SeniorCare HIPAA Privacy Access Request, F13162 (PDF)
• Wisconsin SeniorCare HIPAA Privacy Accounting Request, F-13163 (PDF)
• Wisconsin SeniorCare HIPAA Privacy Alternate Communication Request, F-13164 (PDF)
• Wisconsin SeniorCare HIPAA Privacy Amendment Request, F-13165 (PDF)
• Wisconsin SeniorCare HIPAA Privacy Complaint, F-13166 (PDF)
• Wisconsin SeniorCare HIPAA Privacy Restriction Request, F-13168 (PDF)
• Wisconsin SeniorCare HIPAA Privacy Revocation of Authorization, F-13167 (PDF)