Patient Resources
Thank for you choosing Black River Health for your health care needs! We have been providing comprehensive care to families in and around Jackson County for over 80 years. We are happy to provide yours, too.
Your First Visit
To make sure your first visit with us is a success, we have a few tips.
What to bring:
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- Photo ID
- Insurance card or information
- Social security number
- All medications (prescriptions, over the counter medications, supplements) in their original containers
- A method of payment (cash, checkbook, credit card) if your insurance has co-payments, deductibles, or does not cover the service
We ask that you:
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- Arrive 30 minutes early for your first appointment. This way, we can update your insurance information and provide you with important information and policies.
- Bring a list of your health care questions or concerns. This helps us identify the most important topics to cover during your first visit.
- Complete a patient information form. This will help us keep your address, contact information, and emergency contact information up to date.
- Complete a medical records release. This allows us to get records from your previous provider.
Patient Portal
The patient portal is a secure website where you can see your medical history and test results at Black River Health.
Insurance Coverage
Black River Health participates in a variety of health plans, and your plan may require multiple copays, higher deductibles, and coinsurance.
Financial Assistance
Black River Health believes everyone should have access to quality health care. That is why we will not deny you access to health care services even if you are unable to pay.
Cost of Care
Every patient and their needs are different. Your health and insurance coverage will impact how much you will have to pay for your care out of pocket.
Forms
General Forms
Patient Information Form
Allows us to document your address, contact information, and keep your emergency contact information up to date.
Verbal Consent
Allows us to share information with designated family members or other contacts, and to leave a detailed voicemail.
Authorization to Disclose Information
Allows us to share or receive information from other healthcare facilities or providers.
Advance Directives
Allows you to identify a medical decision maker in the event that you are unable to make your own decisions and specify your care decisions.
Pediatric Forms
Consent to Treat a Minor
Permits us to provide medical care to patients under the age of 18 and/or be accompanied by a non-parent/guardian.
Procedure Forms
Esophagogastroduodenoscopy (EGD) Prep Form – English
Provides information about how to prep for an EGD at Black River Health.
Colonoscopy Prep Form – English
Provides information about how to prep for a colonoscopy at Black River Health.
Esophagogastroduodenoscopy (EGD) Prep Form – Spanish
Provides information about how to prep for an EGD at Black River Health.
Colonoscopy Prep Form – Spanish
Provides information about how to prep for a colonoscopy at Black River Health.
Providing Feedback
We are here to provide excellent service, and we want to hear how we can do that for each patient. Black River Health sends surveys to patients via text message after their visits to collect honest feedback from patients. Please complete these surveys so we can better serve you and other patients like you.
Rewarding Excellent Care
If someone at Black River Health provided excellent care, please tell us about it. You can share your gratitude by nominating a nurse for the DAISY Award or a member of your care team for the PETAL Award.
Concerns About Your Care
Please tell a staff member if you have a concern about your care.
- Patients can contact the Compliance Officer or the Quality Director at (715) 284-5361.
- Patients with concerns about billing can contact a patient financial advocate at (715) 284-1368 or (715) 284-3691.
Patients also may voice or mail concerns to the following licensing agencies:
If you have a quality of care concern regarding Krohn Clinic Primary Care, Krohn Clinic Behavioral Health, or Krohn Clinic Laboratory, contact:
The Compliance Team, Inc.
1-888-291-5353
www.thecomplianceteam.org
If you have a quality of care concern regarding all other locations and departments of Black River Health, contact:
The Joint Commission: Office of Quality Monitoring
One Renaissance Blvd
Oakbrook Terrace, IL 60181
1-800-994-6610
complaint@jointcommission.org
If you have a quality of care concern regarding any location of Black River Health, contact:
Wisconsin Division of Quality Assurance
PO Box 2969
Madison, WI 53701-2969
608-264-9888
dhswebmaildqa@dhs.wisconsin.gov
If you are a Medicare Recipient and you believe that your Medicare-covered services are ending too soon, you may also contact Commence Health (formally known as Livanta LLC), the Medicare Beneficiary, and Family Centered Care – Quality Improvement Organization (BFCC-QIO) for Wisconsin at 888.524.9900 (If need TTY: 888.985.8775)
If you are a Medicaid Recipient, you may contact MetaStar, an External Quality Review Organization for Wisconsin at 888-203-8338 or 608-274-1940
Patient Policies
We have policies in place to ensure Black River Health is upholding standards when interacting with patients, including upholding privacy and ensuring non-discrimination.