DHS 120.30(4)(a)5.5. Patient’s school name, if applicable.
DHS 120.30(4)(a)6.6. Patient’s race.
DHS 120.30(4)(a)7.7. Patient’s ethnicity.
DHS 120.30(4)(a)8.8. Patient’s city of residence.
DHS 120.30(4)(a)9.9. Date of patient’s first symptom of current illness, injury or pregnancy.
DHS 120.30(4)(a)10.10. Dates of services provided to patient.
DHS 120.30(4)(a)11.11. Hospitalization dates related to current services provided to patient.
DHS 120.30(4)(a)12.12. Dates patient is unable to work in current occupation.
DHS 120.30(4)(a)13.13. Date of patient admission.
DHS 120.30(4)(a)14.14. Date of patient discharge.
DHS 120.30(4)(a)15.15. Date of patient’s principal procedure.
DHS 120.30(4)(a)16.16. Encrypted case identifier.
DHS 120.30(4)(a)17.17. Insured’s policy number.
DHS 120.30(4)(a)18.18. Insured’s date of birth.
DHS 120.30(4)(a)19.19. Insured’s identification number.
DHS 120.30(4)(a)20.20. Insured’s gender.
DHS 120.30(4)(a)21.21. Medical assistance resubmission code.
DHS 120.30(4)(a)22.22. Medical assistance prior authorization number.
DHS 120.30(4)(a)23.23. Patient’s employer’s name.
DHS 120.30(4)(b)(b) For information submitted by health care providers who are not hospitals or ambulatory surgery centers, patient-identifiable data means all of the following elements:
DHS 120.30(4)(b)1.1. Data elements specified in par. (a) 1. to 3., 13. to 16., 21. and 22.
DHS 120.30(4)(b)2.2. Whether the patient’s condition is related to employment, and the occurrence and place of an auto accident or other accident.
DHS 120.30(4)(b)3.3. Date of first symptom of current illness, of current injury or of current pregnancy.
DHS 120.30(4)(b)4.4. First date of patient’s same or similar illness, if any.
DHS 120.30(4)(b)5.5. Dates that the patient has been unable to work in his or her current occupation.
DHS 120.30(4)(b)6.6. Dates of receipt by patient of medical service.
DHS 120.30(4)(b)7.7. The patient’s city, town or village.
DHS 120.30(5)(5)Additional methods for ensuring confidentiality of data.
DHS 120.30(5)(a)(a) In this subsection, “small number” means any number that is not large enough to be statistically significant, as determined by the department.