THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW CAREFULLY.

OUR COMMITMENT TO YOUR PRIVACY
AgeWell Home Care, LLC is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the treatment and services we provide you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

How we may use and disclose your identifiable health information
Your privacy rights in your identifiable health information
Our obligations concerning the use and disclosure of your identifiable health information
The terms of this notice apply to all records containing your identifiable health information that are created or retained by our organization. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our organization has created or maintained in the past, and for any of your records we may create or maintain in the future. AgeWell Home Care LLC will post a copy of our most current notice in our offices in a prominent location, and provide you with a copy of our most current notice.

IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Our Privacy Officer

WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS:

The following categories describe the different ways in which we may use and disclose your identifiable health information.

Treatment. We may disclose information about you to any AgeWell Home Care LLC personnel who are involved in your care. For example, your direct care staff may need to share information about your medications with your care manager. Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children or parents.

Payment. AgeWell Home Care LLC may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your services and items to determine if your insurer will cover, or pay for, those items and services. We also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and items.

Health Care Operations. AgeWell Home Care LLC may use and disclose your identifiable health information to operate our business. For example we may use your health information to evaluate the quality of care you receive from us, or to decide if we should recommend a change or modification to your services.

Appointment Reminders. AgeWell Home Care LLC may use and disclose your identifiable health information to contact you and remind you of visits/deliveries.

Health-Related Benefits and Services. AgeWell Home Care LLC may use and disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.

Release of Information to Family/Friends. AgeWell Home Care LLC may release your identifiable health information to a friend or family member that is helping you pay for your health care, or assisting in your care.

Disclosures Required by Law. AgeWell Home Care LLC will use and disclose your identifiable health information when we are required to do so by federal, state or local law.

USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES.

The following categories describe unique scenarios in which we may use or disclose your identifiable health information.

Public Health Risks. Our organization may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:

Maintaining vital records, such as births and deaths
Reporting child abuse or neglect
Preventing or controlling disease, injury or disability
Notifying a person regarding potential exposure to a communicable disease
Notifying a person regarding a potential risk for spreading or contracting a disease or condition
Reporting reactions to drugs or problems with products or devices
Notifying individuals if a product or device that may be using has been recalled
Notifying appropriate government agency (ies) and authority (ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

Health Oversight Activities. AgeWell Home Care LLC may disclose your identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings. If you are involved in a lawsuit or dispute, or if there is a lawsuit or dispute concerning your services, we may disclose information about you in response to a court or administrative order. We may also disclose information about you in response to a subpoena, discover request, or other lawful process from someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement.

Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement
Concerning a death we believe might have resulted from criminal conduct
Regarding criminal conduct at our offices
In response to a warrant, summons, court order, subpoena or similar legal process
To identify/locate a suspect, material witness, fugitive or missing person
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity of location of the perpetrator)

Serious Threats to Health or Safety. AgeWell Home Care may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Military. AgeWell Home Care may disclose your identifiable health information if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.

National Security. AgeWell Home Care LLC may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Inmates.

(a) for the institution to provide health services to you,
(b) for the safety and security of the institution, and/or
(c) to protect your health and safety or the health and safety of other individuals.

Workers' Compensation. Our organization may release your identifiable health information for workers' compensation and similar programs.

YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION
You have the following rights regarding the identifiable health information that we maintain about you:

Confidential Communications. You have the right to request that our organization communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request to Privacy Officer at 4940 Viking Drive, Suite 545, Edina, MN 55435 specifying the requested method of contact, or the location where you wish to be contacted. Our organization will accommodate reasonable requests. You do not need to give a reason for your request.

Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment, or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do not agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your identifiable health information, you must make your request in a clear and concise fashion; (a) the information you wish restricted; (b) whether you are requesting to limit our practice's use, disclosure or both; and (c) to whom you want the limits to apply.

Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing record. You must submit your request in writing to Privacy Officer at 4940 Viking Drive, Suite 545, Edina, MN 55435 in order to inspect and/or obtain a copy of your identifiable health information. Our organization may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional, chosen by us.

Amendment.

(a) accurate and complete;
(b) not part of the identifiable health information kept by or for the organization;
(c) not part of the identifiable health information which you would be permitted to inspect and copy;
(d) and/or not created by our organization, unless the individual or entity that created the information is not available to amend the information.

Accounting of Disclosures. All of our clients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain disclosures our organization has made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to Privacy Officer at 4940 Viking Drive, Suite 545, Edina, MN 55435. All requests for an "accounting of disclosures" must state a time period which may not be longer than six years and may not include dates before October 1, 2004. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12 month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice any time. To obtain a copy of this notice, contact our Privacy Officer at (952) 345-8770.

Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our organization, contact our Privacy Officer at (952) 345-8770 and/or send your written complaint to AgeWell Home Care, LLC, 4940 Viking Drive, Suite 545, Edina, MN 55435. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures. AgeWell Home Care, LLC will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. You may revoke any authorization you provide to us regarding the use and disclosure of your identifiable health information at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note, we are required to retain records of your care.

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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW CAREFULLY.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW CAREFULLY.