HIPAA Joint Privacy Notice

THIS JOINT 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.

Introduction

This Joint Privacy Notice ("Notice") is being provided to you on behalf of Tender Home Care LLC, an Indiana limited liability company ("Tender Home Care"), and the employees, caregivers, and practitioners that work with Tender Home Care with respect to services provided through our Structured Family Caregiving (SFC) program (collectively referred to herein as "we," "our," or "us").

We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of "Protected Health Information" (or "PHI"), which includes any individually identifiable information that we obtain from you or others that relates to your past, present, or future physical or mental health, the health care you have received, or payment for your health care.

We will share PHI with one another, as necessary, to carry out treatment, payment, or health care operations relating to the services provided through the SFC program. As required by law, this Notice provides you with information about your rights and our duties and privacy practices with respect to the privacy of PHI. This Notice also discusses the uses and disclosures we will make of your PHI.

We must comply with the provisions of this Notice as currently in effect, although we reserve the right to change the terms of this Notice from time to time. You can always request a written copy of our most current privacy notice by emailing us at info@tenderhome.care.

Permitted Uses and Disclosures

We can use or disclose your PHI for purposes of treatment, payment, and health care operations, which we describe below with examples.

Treatment. Treatment means the provision, coordination, or management of your health care, including consultations and referrals between health care providers relating to your care. For example, information about your care needs may be shared between your caregiver, Caregiver Coach or registered nurse, and other health care providers involved in your care in order to develop and update your care plan. We may also need to share information with Indiana's Area Agencies on Aging (AAAs) or other state agencies to coordinate your enrollment and ongoing services under the SFC program.

Payment. Payment means our activities to obtain reimbursement for the health care provided to you, including billing, collections, claims management, determinations of eligibility and coverage, and other utilization review activities. For example, we may need to provide PHI to Indiana Medicaid, the Indiana Family and Social Services Administration (FSSA), or other state agencies to determine whether services will be covered, to process waiver enrollment, or to obtain payment for services provided through the SFC program.

Health Care Operations. Health care operations means the support functions related to treatment and payment, such as quality assurance activities, case management, responding to comments and complaints, compliance programs, audits, business planning, development, and administrative activities. For example, we may use your PHI to evaluate the performance of our caregivers and staff when providing care to you. We may also combine PHI about many clients to decide what additional services we should offer, evaluate program effectiveness, or support state-required reporting.

We may also disclose PHI for review and learning purposes. In addition, we may remove information that identifies you so that others can use the de-identified information to study health care and health care delivery without learning who you are.

Other Uses and Disclosures of PHI

We may also use your PHI in the following ways:

Appointment and Visit Reminders. To provide reminders for scheduled home visits, care plan reviews, or other appointments related to your care or the SFC program.

Treatment Alternatives and Health-Related Benefits. To tell you about or recommend possible treatment alternatives or other health-related benefits and services that may be relevant to you.

Individuals Involved in Your Care. To your family members, friends, or any other individual identified by you, to the extent directly related to such person's involvement in your care or the payment for your care. We may use or disclose your PHI to notify, or assist in the notification of, a family member or another person responsible for your care about your location or general condition. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, based upon our professional judgment.

Disaster Relief. When permitted by law, we may coordinate our uses and disclosures of PHI with public or private entities authorized by law or by charter to assist in disaster relief efforts.

Personal Representatives. We will allow your family and friends to act on your behalf to pick up medical supplies, care plan documents, and similar forms of PHI, when we determine, in our professional judgment, that it is in your best interest to make such disclosures.

Research. We may use or disclose your PHI for research purposes, subject to the requirements of applicable law. When required, we will obtain a written authorization from you prior to using your health information for research.

Required by Law. We will use or disclose PHI about you when required to do so by applicable law.

Employer Disclosures. In accordance with applicable law, we may disclose your PHI to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury. You will be notified of these disclosures as required by applicable law.

Incidental uses and disclosures of PHI sometimes occur and are not considered to be a violation of your rights. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures that are limited in nature and cannot be reasonably prevented.

Special Situations

Subject to the requirements of applicable law, we will make the following uses and disclosures of your PHI:

Organ and Tissue Donation. If you are an organ donor, we may release PHI to organ procurement or transplant agencies as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans. If you are a member of the Armed Forces, we may release PHI about you as required by military command authorities.

Worker's Compensation. We may release PHI for programs that provide benefits for work-related injuries or illnesses.

Public Health Activities. We may disclose PHI about you for public health activities, including disclosures to prevent or control disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to persons subject to the jurisdiction of the Food and Drug Administration (FDA) for activities related to FDA-regulated products or services and to report reactions to medications or problems with products; and to notify a person who may have been exposed and may be at risk of a disease.

Health Oversight Activities. We may disclose PHI to federal or state agencies that oversee our activities (for example, providing health care, seeking payment, and civil rights compliance).

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose PHI subject to certain limitations.

Law Enforcement. We may release PHI if asked to do so by a law enforcement official in response to a court order, warrant, or summons; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime under certain limited circumstances; about a death we believe may be the result of criminal conduct; about criminal conduct on our premises; and in emergency circumstances, to report a crime.

Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner, medical examiner, or funeral director as necessary to carry out their duties.

National Security and Intelligence Activities. We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law, or for the protection of the President or foreign heads of state.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release PHI about you to the correctional institution or law enforcement official as necessary to provide you with health care, protect your or others' health and safety, or for the safety and security of the correctional institution.

Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose PHI if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or is necessary for law enforcement authorities to identify or apprehend an individual.

HIV-related information, genetic information, alcohol and/or substance abuse records, mental health records, and other specially protected health information may enjoy certain special confidentiality protections under applicable state and federal law. Any disclosures of these types of records will be subject to these special protections.

Other Uses of Your Health Information

Certain uses and disclosures of PHI will be made only with your written authorization, including uses and/or disclosures:

1. Of psychotherapy notes (where appropriate).
2. For marketing purposes.
3. That constitute a sale of PHI under the Privacy Rule.

Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we have already taken action in reliance on your authorization.

Your Rights

You have the following rights regarding your PHI:

1. Right to Request Restrictions. You have the right to request restrictions on our uses and disclosures of PHI for treatment, payment, and health care operations. We are not required to agree to your request unless the disclosure is to a health plan for payment purposes, the PHI pertains solely to health care items or services for which you have paid in full, and the disclosure is not otherwise required by law. To request a restriction, you may make your request in writing to our Privacy Officer at info@tenderhome.care.

2. Right to Request Confidential Communications. You have the right to reasonably request to receive confidential communications of your PHI by alternative means or at alternative locations. To make such a request, you may submit your request in writing to our Privacy Officer at info@tenderhome.care.

3. Right to Inspect and Copy. You have the right to inspect and copy the PHI contained in our records. In certain limited circumstances, we may be permitted to deny your request, and we will inform you of the basis for such denial. To inspect or obtain a copy of your PHI, you may submit your request in writing to info@tenderhome.care. If you request a copy, we may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request. We may also deny a request for access to PHI under certain circumstances if there is a potential for harm to yourself or others. If we deny a request for this purpose, you have the right to have our denial reviewed in accordance with the requirements of applicable law.

4. Right to Request an Amendment. You have the right to request an amendment to your PHI, but we may deny your request for amendment. In any event, any agreed-upon amendment will be included as an addition to, and not a replacement of, already existing records. To request an amendment to your PHI, you must submit your request in writing to info@tenderhome.care, along with a description of the reason for your request.

5. Right to an Accounting of Disclosures. You have the right to receive an accounting of disclosures of PHI made by us to individuals or entities other than to you for the six years prior to your request, except for certain disclosures precluded by law. To request an accounting of disclosures, you must submit your request in writing to our Privacy Officer at info@tenderhome.care.

6. Right to a Copy of This Notice. You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically. You may request a copy by emailing info@tenderhome.care.

7. Right to Breach Notification. You have the right to receive a notification in the event that there is a breach of your unsecured PHI which requires notification under the Privacy Rule.

Complaints

If you believe that your privacy rights have been violated, you should immediately contact us by emailing info@tenderhome.care. We will not take action against you for filing a complaint.

You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201. Phone: 1-800-368-1019. TDD: 800-537-7697. Complaint forms are available at https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

Non-Discrimination Policy

Tender Home Care complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Tender Home Care does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Tender Home Care provides free aids and services to people with disabilities to communicate effectively with us, such as qualified interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). Tender Home Care also provides free language services to people whose primary language is not English, including qualified interpreters and information written in other languages.

If you need these services, or if you believe that Tender Home Care has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by contacting us at info@tenderhome.care, by phone at (317) 555-0100, or by mail at 1234 Meridian St, Suite 200, Indianapolis, IN 46204.

You can file a grievance in person or by mail, phone, or email. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201. Phone: 1-800-368-1019. TDD: 800-537-7697. Complaint forms are available at https://www.hhs.gov/ocr/office/file/index.html.

Contact Person

If you have any questions or would like further information about this Notice, please contact us:

• Email: info@tenderhome.care
• Phone: (317) 555-0100
• Website: https://tenderhome.care
• Mailing Address: 1234 Meridian St, Suite 200, Indianapolis, IN 46204