All persons who are referred to a Waisman Center Community TIES Program including Crisis Response, must be informed of the “Notice of Privacy Practices” and must complete a “NPP Acknowledgement Form” per HIPAA guidelines.
For more information and to access these forms, please go to the University of Wisconsin HIPAA website.
Adaptation & Modification Program
A&M Referral Form for Adults and Children
Community TIES Program
Wellness Inclusion Nursing (WIN)
WIN Referral Form (Word Document)
WIN Referral Form (Fillable PDF)