VAXPRO COMPLETE PRIVACY POLICY

Vaccination Consent & Health Information Authorization

RECORD RETENTION AND LEGAL REQUIREMENTS

Record Retention Period:

  • Vaccination records will be maintained for a minimum of 6 years from the date of vaccination

  • For minor patients: Records will be maintained for 6 years OR 3 years after the patient reaches age 18, whichever is longer

  • Records may be retained longer if required for medical, legal, or regulatory purposes

Wisconsin Immunization Registry (WIR) Reporting:

  • Wisconsin law requires healthcare providers to report certain immunizations to the Wisconsin Immunization Registry (WIR)

  • This reporting is mandatory for public health monitoring and disease prevention

  • WIR reporting does not require additional patient authorization beyond this consent

  • Information reported includes basic vaccination data (vaccine type, date, provider information)

Healthcare Provider Documentation:

  • Federal law requires documentation of healthcare provider name, credentials, and facility address

  • This information becomes part of your permanent vaccination record

  • Provider signatures and dates are maintained for legal compliance

YOUR PRIVACY RIGHTS

VaxPro is committed to protecting your health information privacy in accordance with federal law (HIPAA) and state regulations. This policy explains your rights regarding vaccination consent and health information release.

RIGHT TO REFUSE AUTHORIZATION

You have the right to refuse to sign any authorization.

  • VaxPro may be unable to provide vaccination services if authorization is necessary for legitimate healthcare operations, treatment, or payment purposes

  • However, we will not condition treatment on authorizations that are not directly related to your care

  • You can choose to authorize release to some recipients but not others

RIGHT TO RECEIVE A COPY

  • You have the right to request and receive a copy of any signed authorization or consent form

  • We will provide copies free of charge upon request

  • Electronic copies can be sent to your email address

RIGHT TO REVOKE AUTHORIZATION

You may cancel any authorization at any time by:

  1. Written Request: Send to VaxPro Privacy Officer, 230 Horizon Dr, Ste #101B, Verona, WI 53593-1299

  2. Email Request: Send to info@vaxpro.com with "Authorization Revocation" in subject line

  3. In Person: Visit our clinic with written revocation request

Important Limitations:

  • Revocation will not affect information already released before we receive your cancellation

  • Your insurance company may still receive information when law allows them to contest claims

  • Some disclosures required by law cannot be revoked

RIGHT TO RESTRICT DISCLOSURES

  • You may request restrictions on how we use or disclose your health information

  • We will consider restriction requests but are not required to agree to all requests

  • You have the right to restrict disclosures to your health plan if you have paid for services out-of-pocket in full

RIGHT TO CONFIDENTIAL COMMUNICATIONS

  • You have the right to request that we communicate with you about your health information in a certain way or at a certain location

  • Examples: only call your cell phone, only email work address, only mail to P.O. Box

  • We will accommodate reasonable requests

VACCINATION CONSENT INFORMATION

VACCINE INFORMATION STATEMENTS (VIS)

Federal law requires that we provide current Vaccine Information Statements before vaccination.

  • VIS documents explain the benefits and risks of each vaccine

  • You must receive and review the VIS before consenting to vaccination

  • VIS edition dates are tracked to ensure you receive current information

  • You have the right to ask questions about any vaccine before receiving it

INFORMED CONSENT REQUIREMENTS

Your vaccination consent confirms that you understand:

  • The purpose and benefits of vaccination

  • Potential side effects and risks (ranging from mild to serious)

  • That no vaccine is 100% effective or completely risk-free

  • That vaccination is voluntary and you may decline

  • Alternative options (including risks of remaining unvaccinated)

  • Post-vaccination care and when to seek medical attention

  • Adverse event reporting through VAERS (1-800-822-7967)

VOLUNTARY NATURE OF CONSENT

  • All vaccination decisions are voluntary

  • You may consent to some vaccines but decline others

  • You may change your mind before vaccination is administered

  • Emergency situations may require different consent procedures

HEALTH INFORMATION RELEASE

INFORMATION WE MAY RELEASE

Vaccination records typically include:

  • Vaccine type(s) received (Influenza, COVID-19, etc.)

  • Date(s) of vaccination

  • Vaccine manufacturer and lot numbers

  • Healthcare provider who administered vaccine

  • Location where vaccine was given

  • Any adverse reactions or side effects noted

  • Follow-up recommendations

Additional information may include:

  • Health screening questionnaire responses

  • Insurance or payment information

  • Appointment dates and times

  • Communication preferences

WHO RECEIVES YOUR INFORMATION

🏠 YOURSELF

  • Purpose: Personal records, employer requirements, travel documentation

  • Method: Email, patient portal, or printed copy

  • Timeline: Within 1-2 business days of vaccination

🏛️ STATE IMMUNIZATION REGISTRY (WISCONSIN IMMUNIZATION REGISTRY - WIR)

  • Purpose: Public health monitoring, outbreak prevention, immunization tracking

  • Legal Basis: Required by Wisconsin state law (Wisconsin Statutes § 450.035(4) and § 447.059(4))

  • Information: Basic vaccination data only

  • Timeline: Within 24 hours of vaccination

  • Note: This reporting is mandatory and does not require additional patient authorization

🏢 YOUR INSURANCE/HEALTH PLAN

  • Purpose: Coverage verification, billing, claims processing

  • Information: Vaccination details, billing codes, provider information

  • Timeline: As needed for billing and coverage purposes

🏭 YOUR EMPLOYER/INSTITUTION

  • Purpose: Meeting workplace immunization requirements

  • Information: Vaccination status, dates, vaccine types

  • Limitations: Only basic compliance information, not detailed health data

  • Timeline: Within 1-2 business days of vaccination

PRIVACY RISKS AND RE-DISCLOSURE

⚠️ IMPORTANT WARNING

Once we release your information to authorized recipients, it may no longer be protected by federal privacy laws.

WHAT THIS MEANS:

  • Employers may include vaccination records in personnel files

  • Insurance companies may share with business partners

  • Schools may report immunization status to state agencies

  • Information may be subject to recipient's record retention policies

  • Future disclosures may occur without additional authorization from you

EXAMPLES OF POTENTIAL RE-DISCLOSURE:

  • Employer shares vaccination status with HR departments, managers, or occupational health providers

  • Insurance company reports vaccination data to claims processors or fraud prevention services

  • School district includes immunization records in student health files or state reporting

  • Information becomes part of employment records subject to background checks

AUTHORIZATION EXPIRATION AND LIMITATIONS

WHEN AUTHORIZATIONS EXPIRE

Automatic Expiration:

  • Upon VaxPro's delivery of vaccination records to your selected recipients, OR

  • One year from the date you sign the authorization

  • Whichever occurs first

WHAT HAPPENS AFTER EXPIRATION

  • We cannot release additional information without new authorization

  • Information already released remains with recipients

  • You would need to sign new authorization for future releases

ONGOING AUTHORIZATIONS

  • Each vaccination visit may require new authorization

  • You can modify recipients for each new authorization

  • Previous authorizations do not automatically apply to new visits

SPECIAL SITUATIONS

EMERGENCY DISCLOSURES

In medical emergencies, we may disclose your health information without authorization if:

  • Necessary to treat you or prevent serious harm

  • Required by emergency medical personnel

  • Needed to contact emergency contacts or family members

DISCLOSURES REQUIRED BY LAW

We may release your information without authorization when required by:

  • Public Health Authorities: Disease outbreak investigations, vaccine safety monitoring

  • Legal Process: Court orders, subpoenas, law enforcement investigations

  • Workplace Safety: Workers' compensation claims, occupational health requirements

  • Government Agencies: FDA adverse event reporting, CDC vaccine safety surveillance

BUSINESS ASSOCIATES

We may share information with companies that provide services to us, including:

  • Electronic health record vendors

  • Billing and insurance processing companies

  • IT support and data backup services

  • Legal and compliance consultants

All business associates sign agreements to protect your information privacy.

MINIMUM NECESSARY STANDARD

We limit disclosures to the minimum information necessary:

  • Employers: Typically receive only vaccination status and dates, not detailed health information

  • Insurance: Receives information necessary for billing and coverage decisions

  • Registries: Receive standardized vaccination data for public health purposes

  • You: Can receive complete vaccination records and related health information

YOUR ADDITIONAL RIGHTS

ACCESS TO YOUR RECORDS

  • You can inspect and obtain copies of your vaccination records

  • We may charge reasonable fees for copying and mailing

  • Electronic copies are usually provided free of charge

AMENDMENT RIGHTS

  • You can request corrections to your vaccination records

  • We will consider all amendment requests

  • You can appeal denied amendment requests

ACCOUNTING OF DISCLOSURES

  • You can request a list of who has received your information

  • Accounting covers disclosures for purposes other than treatment, payment, and operations

  • First accounting each year is free; additional requests may incur fees

BREACH NOTIFICATION

  • We will notify you within 60 days if there is a breach of your unsecured protected health information

  • We will provide information about what happened and steps to protect yourself

  • We will take corrective action to prevent future breaches

CONTACT INFORMATION

QUESTIONS OR CONCERNS

VaxPro Privacy Officer

FILING COMPLAINTS

If you believe your privacy rights have been violated:

VaxPro Complaint Process:

  • Contact our Privacy Officer using information above

  • Submit complaints in writing when possible

  • We will investigate and respond to all complaints

Federal Complaint Process:

No Retaliation: You will not be penalized or retaliated against for filing a complaint or exercising your privacy rights.

CONSENT AND ACKNOWLEDGMENT

By providing consent for vaccination and authorizing release of information, you acknowledge that:

  • You have read and understand this privacy policy

  • You understand the benefits and risks of vaccination

  • You understand who will receive your information and why

  • You understand the risks of re-disclosure by recipients

  • You know your rights regarding your health information

  • You are making voluntary decisions about vaccination and information sharing

  • You understand how to revoke authorizations if you change your mind

  • You understand that Wisconsin law requires reporting to the Wisconsin Immunization Registry (WIR)

  • You confirm that you are at least 18 years old OR you are the legal parent/guardian authorized to make healthcare decisions for the minor patient

  • You understand the record retention requirements and timeframes

EFFECTIVE DATE AND UPDATES

Effective Date: July 23, 2025

Policy Updates:

  • We reserve the right to update this policy as laws and regulations change

  • Updated policies will be posted on our website

  • Material changes will be communicated to patients

  • You can always request the current version of this policy

This policy supplements VaxPro's complete Notice of Privacy Practices, which provides additional detail about our privacy practices and is available upon request.