Open General Consent for Treatment

To make a medical, behavioral health or substance abuse appointment please call:

Milwaukee | 414-672-1353

Waukesha | 262-408-2530

For questions about test results or to leave a message with your provider please call:

Milwaukee | 414-672-1353

Waukesha | 262-408-2530

Sixteenth Street accepts all people - whether you have insurance or not.

We accept:

• Most commercial insurance
• BadgerCare Plus
• Medicare

If you are uninsured, you are welcome at Sixteenth Street. You will go on what we call our Sliding Fee Scale. See answers to our frequently asked questions below:

Sliding Fee Scale - FAQ

What is the Sliding Fee Discount Program?

The Sliding Fee Discount Program is a Federal program that allows Sixteenth Street  to discount our normal charges for health care services we provide. The Sliding Fee Discount Program is available to all patients regardless of immigration or insurance status.  Sixteenth Street will never deny health care based on the patients inability to pay.

Who can apply for the Sliding Fee Discount Program?

Anyone is welcome to apply for the Sliding Fee Discount Program. All patients without insurance MUST be evaluated for the Sliding Fee Discount Program. If you refuse to be evaluated and provide the required documentation you can not receive a discount under the Sliding Fee Scale.  

Approval for the program is based on family size and combined household income in accordance with the Federal Poverty Guidelines- http://aspe.hhs.gov/poverty

If you are eligible for other assistance programs, such as Medicaid, we will assist you in applying for these programs in addition to the Sliding Fee Discount Program.

How is eligibility for the Sliding Fee Discount Program determined?

Eligibility is based on the family size and combined household income. You must show proof of income from the last 30 days for all family members living in your household.  If you do not provide proof of income or you do not qualify based on your income and family size, you will have to pay the full charges for your services.

How do I apply for the Sliding Fee Discount Program?

You must meet with a Financial Counselor to apply for the Sliding Fee Discount Program. You can schedule an appointment at any of our front desks or you can call 414-672-1353 Option 3 and schedule an appointment.

Are appointments required or can I just walk in?

Appointments are encouraged to reduce waiting times to speak with the Financial Counselor. If you would like you may walk in and speak to a Financial Counselor at any of our locations, Monday – Friday between the hours of 8:00 AM – 5:00 PM.

You can schedule an appointment by contacting Patient Financial Services at 414-672-1353 Option 3.

What type of documents do I need to bring to apply for Sliding Fee Program?

You will need to bring in proof of income (last 30 days) for all family members living in the household. You will also need to fill out the “SSCHC-Patient Information Form”.

What can be used as Proof of Income?

The following documents are acceptable to bring for evaluation of the sliding fee. This is required for all members of a household (not including roommates/non-family members) and will be used to figure how much of a discount you will receive.

• Prior year income tax return or W-2
• Check stubs from the 4 weekly or 2 biweekly pay periods preceding the application
• Un-employment check(s)
• Social Security (SSI) checks or statements
• Pension checks
• Alimony, child support, etc.
• Attestation of income by employer
• Bank statements to verify any direct deposits

Who is considered “family” in regards to determining the number of dependents for the Sliding Fee Discount Program?

Family size is defined as Mother, Father, Children, Significant Other, Husband, Wife and any dependent adult or child who is supported by the family unit and benefits from the combined household income. Roommates DO NOT qualify as ‘Family’.  Unborn children are not included in the calculation of family size.

• Children up to 18 years old, living at home, qualify as a dependent and their income will not count toward the families’ income
• Children 18-21 years old, who are in college and still live at home, will qualify as a dependent their income will not count toward the families’ income
• Children over 18 years old, not in school and are working, will be considered on their own income and will not count as a dependent
• Elderly parents living with their grown children, who do not have any type of Social Security, pension, or income count as a dependent.

Is my lab work covered under the Sliding Fee Discount Program?

All patients who are approved for the Sliding Fee Discount Program at the time of the lab service will have their labs covered at no cost to the patient.

Are my medications covered under the Sliding Fee Discount Program?

Patients without any insurance who have been approved for the Sliding Fee Discount Program may be able to receive a help paying for prescription medicines through Sixteenth Street's 340B drug pricing program. This program is only available at pharmacies that work with Sixteenth Street. If you are approved for the Sliding Fee Discount Program and are also eligible for help with your prescription medicine, you will be given a list of pharmacies that accept our discount.

Any patient with third party insurance, whether a drug benefit exists or not, are NOT eligible for this program.

When is my sliding fee scale effective?

The sliding fee is active the same day as you are approved.

When does my Sliding Fee Discount expire?

The sliding fee is active for 1 year from the approval date.

You must re-apply prior to expiration date in order to continue being covered under the Sliding Fee Discount Program. If you do not re-apply before your expiration date, you may have to pay any charges for services that happened during that period after the expiration date until you re-enroll.

What services does the Sliding Fee Discount Program cover?

The sliding fee scale applies only to those services provided directly by or controlled by Sixteenth Street. Services provided under referral are NOT covered by the Sixteenth Street Sliding Fee Program.

Some examples of services that are covered are: medical visits, behavioral health visits, alcohol and other drug abuse (AODA) services, and physical therapy.

I do not want to provide my financial information. Am I still eligible for the Sliding Fee Discount Program?

Eligibility for the Sliding Fee Discount program is based on your income and family size. If you choose not to provide Sixteenth Street with this information you will be responsible for the total charges for services rendered.

How often do I need to apply for the Sliding Fee Discount Program?

You must apply every year. You may re-apply sooner than 1 year if there is a change in your current household size or income.

How much will I pay if I am approved for the Sliding Fee Discount Program?

The charge for your visit depends on your income, family size, and the type of service you received. When you are approved for the Sliding Fee Discount Program you will receive a card as well as a handout that details your financial responsibility for services rendered. Payments are due at the time of service.

I cannot pay my bill from the clinic. What should I do?

Contact Patient Financial Services as soon as possible, 414-672-1353 Option 3, and speak with a Financial Counselor. They will help you explore other options to assist you in paying your balance. Sixteenth Street will never deny health care due to a patient’s inability to pay for the services.

I have a question regarding the sliding fee program or my bill from the clinic. Who should I contact?

Patients are encouraged to call 414-672-1353 Option 3 to be connected to our Patient Financial Services Department, who can assist with those questions. If you wish to come in person you may do so at the following locations:

Parkway Clinic
2906 S. 20th Street
Milwaukee, WI 53215

Chavez Clinic
1032 S. Cesar E. Chavez Drive
Milwaukee, WI 53204

Hours:

Monday - Friday | 8:00 AM - 4:30 PM

Give us a call:

Milwaukee | 414-672-1353

Waukesha | 262-408-2530

Send us a fax:

Milwaukee | 414-672-4265

Waukesha Medical | 262-408-5083

Waukesha Behavioral Health & AODA | 262-349-9634

Prices

Vaccines
$2.00

Copies of Medical Records (labs, office notes, diagnostic imaging, etc.)
$1.07 per page (1st 25 pages)
$0.79 per pages 26-50
$0.53 per pages 51-100
$0.31 per pages 101-more

USB Flash Drive
$6.00 + 10% of total costs for copies required in 7 or less days

Notarizing
$5.00

ID IS REQUIRED!

Our Patient Financial Services Department can help you with all your needs regarding bills and paying for your care at the clinic.

It is best to call and make an appointment to make sure you are able to be seen, but walk-ins are accepted.

Parkway Clinic | Lower Level
2906 S. 20th Street
Milwaukee, WI 532015
414-672-1353 (option 3)

Chavez Clinic | 2nd Floor, Room 222
1032 S. Cesar E. Chavez Drive
Milwaukee, WI 53204
414-672-1353 (option 3)

If you cannot pay your bill from the clinic:

Contact Patient Financial Services as soon as possible at 414-672-1353 Option 3 to speak with a Financial Counselor. They will help you explore other options to assist you in paying your balance. Sixteenth Street will never deny healthcare due to a patient’s inability to pay for the services.

If you have a question regarding the sliding fee program or a bill from the clinic:

Call 414-672-1353 Option 3 to be connected to our Financial Services Department who can assist with those questions.

If you wish to come in person you may do so at our Chavez or Parkway clinics.

WIAA Physical Extension Form - ENGLISH

Formulario de extensión física de WIAA - ESPANOL

Preparticipation Evaluation - History Form - ENGLISH

Evaluación Física Previa a La Participación - Formulario de Historial Clínico - ESPANOL

Obesity Handouts

As a patient of Sixteenth Street Community Health Centers, you have the right:

To Quality Care

Efficient, economical and quality care at professional standards provided with an emphasis on safety.

To Respectful Treatment

Courteous, and considerate treatment will be provided at all times.  We will respect your personal dignity and your personal beliefs and values. We will not discriminate in the provision of services to you based on your ability to pay, or because payment for those services would be made under Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP); economic or educational status; the color of your skin; your cultural, spiritual, psychosocial background; your national origin or sexual orientation or gender identification. If you have a complaint about your care or treatment you have the right to make that complaint to appropriate clinic personnel.

To Be Involved in your Health Care

You have the right ask questions to be able to understand diagnosis, treatment, prognosis and possible need for future treatment.  You have the right to full disclosure of health information and available options about the proposed treatment plan or procedure. This will enable you to refuse any procedure or treatment to the extent permitted by law.  Sixteenth Street offers assistance to patients who want to issue advance directives about their health care.  It is the patient’s responsibility to notify Sixteenth Street if they already have issued advance directives and to supply a copy to the clinic.

To Access to your Health Information

You have the right to access and possess copies of your health information (medical records) after your written permission is obtained.  A reasonable fee may be required.  You also have the right to request amendment to your health information records.  Please refer to the Sixteenth Street Community Health Center’s Notice of Privacy Practices for further information on your Health Information Rights.

To Privacy

You have the right to confidentiality in handling communications, case discussions, consultations, examinations and records pertaining to your care.  These services are conducted discreetly and will not be shared except through authorized legal disclosure. You have the right to privacy while receiving services or treatment and to request an accounting of any disclosures made.  If you have a specific or sensitive health concern or issue, you may contact our social services department for additional assistance. Please refer to the Sixteenth Street Community Health Center’s Notice of Privacy Practices for further information on your Health Information Rights as well as how we may use and disclose your information.

To Continuity Of Care

You have the right to reasonable continuity of care that recognizes current and future treatment needs.  You have the right to receive instruction on how such care may be obtained, knowing the name of your current provider and receiving information in advance the time(s) of an appointment as well as the provider delivering future service or care.

To Information about Financial Charges

You have the right to receive information about charges for which you will be responsible and explanations of your bill regardless of source of payment. Minimum reasonable fees may be required.

You have the Responsibility:

To Show Respect and Consideration

You have the responsibility to value your health and keep all appointments. Please notify the clinic in person or by phone by calling receptionist at least two hours prior to your scheduled appointment if you cannot keep the appointment.   Sixteenth Street reserves the right to dismiss patients who no-show for appointments.

To Follow Rules and Regulations

You have the responsibility (for yourself and any minors in your charge) to be considerate and respectful of other patients and clinic staff and their property.  This includes obeying clinic rules and regulations affecting patient care, conduct and public health by assisting with control of noise, and refraining from smoking, eating and drinking while in the clinic.

To Maintain Reasonable Expectations

You have the responsibility to recognize that the types and length of illnesses may vary, and that even with the best available care, outcomes may not always be satisfactory but reasonable.

To Report Information

You have the responsibility to give your provider correct and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health.  It is your responsibility to report changes in your health conditions to a provider, nurse or other clinical personnel. 

Additionally, you have the responsibility to notify clinic staff of any changes to your contact information (address, phone number, insurance status) or special needs that you have such as translation assistance or legal guardian requirements that may be needed for your treatment or the treatment of minors or dependent patients in your care.

To Ask Questions

You have the responsibility to become informed and knowledgeable about your body in health and disease.  Tell your provider, nurse, or other person caring for you if you do not understand the care, treatment or service that is being provided and what is expected of you.

To Follow Instructions and Accept Consequences

You have the responsibility, following the informed consent and decision making process, to follow the instructions of the providers, nurses, and other persons treating you, to implement and follow through on treatment plan as prescribed and to accept the consequences if you refuse treatment or do not follow instructions.

To Protect your Health 

You have the responsibility to be informed concerning preventive health measures, to begin appropriate health behavior, and to seek help at the earliest signs of illness.

To Meet Your Financial Obligation

You have the responsibility to accept and meet financial obligations incurred by making prompt payments for services provides, including copayments, deductibles and any other covered charges.  You are also responsible for complying with Sixteenth Street Community Health Center’s financial screening guidelines and requesting information about payment options.

If you do not understand, or need help understanding your rights and responsibilities, please contact a staff member.

Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.  Please review it carefully.  If you have any questions about this Notice, please contact the Privacy Officer.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices.  We may change the terms of our notice, at any time.  The new notice will be effective for all protected health information that we maintain at that time.  Upon your request, we will provide you with any revised Notice of Privacy practices by calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.

Following are examples of the types of uses and disclosures of your protected health care information that the physician’s office is permitted to make once you have signed our consent form.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided consent.

Treatment, Payment, Healthcare Operations:  We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  This includes the coordination of management of your health care with a third party that has already obtained your permission to have access to your protected health information.  For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose your protected health information to other physicians who may be treating you when we have the necessary permission from you to disclose your protected health information.  For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

Your protected health information will be used, as needed, to obtain payment for your health care services.  This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.  For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice.  These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and conducting or arranging for other business activities.

For example, we may disclose your protected health information to medical school students that see patients at our office.  In addition, we may call you by name in the waiting room when your physician is ready to see you.  We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice.  Whenever an arrangement between our office and a business associate involves the use of disclosure of your protected health information.  See Consent for Purpose of Treatment, Payment and Healthcare Operations form.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.  We may also use and disclose your protected health information for other marketing activities.  For example, your name and address may be used to send you a newsletter about our practice and the services we offer.  We may also send you information about products or services that we believe may be beneficial to you.  You may contact our Privacy Officer to request that these materials not be sent to you.

In compliance with federal and state laws, we may make your protected health information available electronically through an electronic health information exchange to other health care providers and health plans that request your information for purposes of Treatment, Payment, and Health Care Operations; and to public health entities as permitted by law. Participation in an electronic health information exchange also lets us see other providers’ and health plans’ information about you for purposes of Treatment, Payment, and Health Care Operations.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.  You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made with Your Consent, Authorization or Opportunity to Object 

We may use and disclose your protected health information in the following instances.  You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.  If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest.  In this case, only the protected health information that is relevant to your health care will be disclosed.

Others Involved in Your Healthcare:  Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care.  If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.  We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.  Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies:  We may use or disclose your protected health information in an emergency treatment situation.  If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment.  If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information to treat you.

Communication Barriers:  We may use and disclose your protected health information if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to sub-communication barriers and the physician determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your consent or authorization.  These situations include:

• Abuse or Neglect
• Food and Drug Administration
• Legal Proceedings
• Law Enforcement
• Coroners, Funeral Directors, and Organ Donation
• Research
• Criminal Activity
• Military Activity and National Security

Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information.  This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information.  A “designated record set” contains medical and billing records and any other records that your physician and the practice uses for making decisions about you.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.  Depending on the circumstances, a decision to deny access may be reviewable.  In some circumstances, you may have a right to have this decision reviewed.  Please contact the Privacy Officer if you have questions about access to your medical records.

You have the right to request a restriction of your protected health information.  This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request.  If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted.  If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.  With this in mind, please discuss any restriction you wish to request with your physician.  You may request a restriction by contacting the Privacy Officer.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  We will accommodate reasonable requests.  We may also condition this accommodation by asking you for your information as to how payment will be handled or specification of an alternative address or other method of contact.  We will not request an explanation from you as to the basis for the request.  Please make this request in writing to our Privacy Officer.

You may have the right to have your physician amend your protected health information.  This means you may request an amendment of protected health information about you in a designated records set for as long as we maintain this information.  In certain cases we may deny your request for an amendment.  If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.  Please contact our Privacy Officer to determine if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.  This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices.  It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes.  You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.  You may request a shorter timeframe.  The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us, upon requests, even if you have agreed to accept this notice electronically.

Complaints. You may submit a complaint if you believe we have violated your privacy rights by notifying our Privacy and/or Safety Officer.  You also have the right to file a complaint with HRSA (https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html)  or with The Joint Commission. (630-792-5800). We will not retaliate against you for filing a complaint. Your complaint or concern can be submitted anonymously, if you prefer.

Privacy Officer: 414-897-5165
Vice President Human Resources : 414-897-5154

VIEW LARGER VERSION

Good Faith Estimate

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.

In 2013 Sixteenth Street received recognition as a Level 3 Patient Centered Medical Home (PCMH) by the National Committee on Quality Assurance and in 2018 was accredited by the Joint Commission as a Primary Care Medical Home.  

This means that we comply with standards that emphasize the use of systematic, patient-centered, coordinated care that supports access, communication and patient involvement.

What does this mean for me as a patient?

We are committed to facilitating an ongoing relationship with your personal physician and care team, all of whom work to provide evidence based, continuous and comprehensive care for the “whole you” including Behavioral Health. We will provide you access to care when it is needed by offering a good range of hours and will assist you when we are “closed”. Good communication, regular visits, and coordinated care with specialists are vital to the Provider-patient relationship so we will help you to coordinate that care. We will do that by asking you about other visits and by working with other area healthcare providers to share authorized information. We will partner with you to ensure that your care plan respects your wants, needs, and preferences and those of your family when appropriate; We will have educational and support resources to help you make decisions and fully participate in your own care.

We will keep a careful watch on the number of patients assigned to your Provider so that you have the ability to get in when it is necessary. We will strive to make scheduling appointments as easy as possible for you when you call.  We will avoid last minute changes to your appointment and will try to accommodate your scheduling needs. Every attempt will be made to notify you of any scheduling changes that must occur and with as much notice as possible. We will also let you know, upon arrival, if we are running behind schedule and assist you with rescheduling that appointment if you can not wait.

We ask you to be honest about your condition, keeping us informed about changes, concerns and care received outside of our health center. You are expected to notify us if you are unable to keep your appointments. Calling us up to 2 hours before your appointment will be considered a cancellation rather than a failed appointment. If you fail more than 2 appointments within a 12 month period you will face dismissal from our clinic. You may not be seen if you arrive late and it may be considered a missed appointment. Please arrive 5 minutes before your scheduled appointment to allow for such things as parking, checking in, and giving your co-pay

Sixteenth Street Community Health Centers (SSCHC) is committed to providing clinical services to all patients seeking primary health care and behavioral health care and guides patients through the selection of a primary medical team. SSCHC does not discriminate in the provision of services to an individual because the individual is unable to pay; because payment for those services would be made under Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP); or based upon the individual’s race, skin color, sex, national origin, disability, religion, age, sexual orientation, or gender identity.