PRIVACY POLICY/TERMS OF SERVICE

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.

Christian Servants Home Care Texas, LLC is required by law to maintain the privacy of your protected health information; to notify you following a breach of unsecured protected health information; to provide you this detailed Notice of the Agency’s legal duties and privacy practices relating to your protected health information, to abide by the terms of the Notice that are currently in effect. Christian Servants Home Care Texas, LLC keeps a record of your care services we provide you. You may ask us to see and copy that record. You may also ask us to correct that record. We will not disclose your records to others unless you direct us to do so or unless the law authorizes or compels us to do so. You may see your record or get information about it at the location that provides you care.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND CARE OPERATIONS

To provide Treatment. Christian Servants Home Care Texas, LLC may use and disclose your protected health information to others involved in your care, such as your attending physician and other health care professionals who have agreed to assist Christian Servants Home Care Texas, LLC in coordinating care. Christian Servants Home Care Texas, LLC, also may disclose your health care information to individuals outside of the Christian Servants Home Care Texas, LLC involved in your care including your primary family caregiver, pharmacists, suppliers of medical equipment, or other health care professionals. To Obtain Payment. Christian Servants Home Care Texas, LLC may use and disclose your protected health information for billing and payment purposes or for the billing and payment needs of other care providers. For example, Christian Servants Home Care Texas, LLC may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Christian Servants Home Care Texas, LLC. Christian Servants Home Care Texas, LLC also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for home care, hospice, and the services that will be provided to you. To Conduct Operations. Christian Servants Home Care Texas, LLC may use and disclose protected health information for its own operations in order to facilitate the function of the Christian Servants Home Care Texas, LLC and as necessary to provide quality care to all of the Christian Servants Home Care Texas, LLC patients. Care operations include such activities as quality improvement, cost containment, case management activities, performance evaluation training of employees and students, accreditation, auditing, and business planning. Christian Servants Home Care Texas, LLC also may disclose your protected health information for certain operations purposes of other covered entities, such as for compliance and quality assurance purposes.

SPECIFIC USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

When Legally Required. The Christian Servants Home Care Texas, LLC may disclose your protected health information when it is required to do so by any federal, state, or local law. To Individuals Involved in Your Care. Unless you object, the Christian Servants Home Care Texas, LLC may disclose your protected health information to a family member, close personal friend, or other person you identify, including clergy, who is involved in your care. Emergencies. We may use and disclose your protected health information in emergency treatment situations. To Business Associates. Christian Servants Home Care Texas, LLC’s business associates are individuals and organizations that carry out functions or activities on Christian Servants Home Care Texas, LLC's behalf that involve protected health information. Christian Servants Home Care Texas, LLC may disclose your protected health information to a business associate who needs the information to perform services for or on behalf of Christian Servants Home Care Texas, LLC. Further, Christian Servants Home Care Texas, LLC business associates have agreed to preserve the confidentiality of this information. Public Health Activities. Christian Servants Home Care Texas, LLC may disclose your protected health information for public health activities in order to prevent or control disease, report disease or death, or report adverse events with products or medication, for example. To Report Abuse, Neglect Or Domestic Violence. If Christian Servants Home Care Texas, LLC believes that you have been a victim of abuse, neglect or domestic violence, Christian Servants Home Care Texas, LLC may use and disclose your protected health information to notify a government authority if authorized by law or if you agree to the report. To Conduct Health Oversight Activities. Christian Servants Home Care Texas, LLC may disclose your protected health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action, and for activities involving government oversight of the health care system. In Connection With Judicial and Administrative Proceedings. Christian Servants Home Care Texas, LLC may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only if certain conditions are met. For Law Enforcement Purposes. Christian Servants Home Care Texas, LLC may disclose your protected health information to a law enforcement oAicial for certain law enforcement purposes, including, for example, to comply with reporting requirements, to comply with a court order, warrant, or similar legal process; or to respond to certain requests for information concerning crimes. To Coroners and Medical Examiners. Christian Servants Home Care Texas, LLC may disclose your protected health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law. To Funeral Directors. Christian Servants Home Care Texas, LLC may disclose your protected health information to funeral directors, consistent with applicable law, as necessary, to carry out their duties with respect to your funeral arrangements. For Organ, Eye, or Tissue Donation. When directed, Christian Servants Home Care Texas, LLC may use and disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of facilitating the donation and transplantation. For Research Purposes. Christian Servants Home Care Texas, LLC may, under very select circumstances, use and disclose your protected health information for research purposes if the privacy aspects of the research have been reviewed and approved, if the researcher is collecting information in preparing a research proposal if the research occurs after your death, or if you authorize the use or disclosure. To Conduct Health Oversight Activities. Christian Servants Home Care Texas, LLC may disclose your protected health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action, and for activities involving government oversight of the health care system. In Connection With Judicial and Administrative Proceedings. Christian Servants Home Care Texas, LLC may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only if certain conditions are met. For Law Enforcement Purposes. Christian Servants Home Care Texas, LLC may disclose your protected health information to a law enforcement oAicial for certain law enforcement purposes, including, for example, to comply with reporting requirements, to comply with a court order, warrant, or similar legal process; or to respond to certain requests for information concerning crimes. To Coroners and Medical Examiners. Christian Servants Home Care Texas, LLC may disclose your protected health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law. To Funeral Directors. Christian Servants Home Care Texas, LLC may disclose your protected health information to funeral directors, consistent with applicable law, as necessary, to carry out their duties with respect to your funeral arrangements. For Organ, Eye, or Tissue Donation. When directed, Christian Servants Home Care Texas, LLC may use and disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of facilitating the donation and transplantation. For Research Purposes. Christian Servants Home Care Texas, LLC may, under very select circumstances, use and disclose your protected health information for research purposes if the privacy aspects of the research have been reviewed and approved, if the researcher is collecting information in preparing a research proposal if the research occurs after your death, or if you authorize the use or disclosure.

USES AND DISCLOSURES WITH YOUR AUTHORIZATION

Christian Servants Home Care Texas, LLC will obtain your authorization for: (1) most uses and disclosures of psychotherapy notes (as defined by HIPAA); (2) uses and disclosures of protected health information for marketing purposes; and (3) disclosures that constitute a sale of protected health information. Other than as stated above in the Notice, Christian Servants Home Care Texas, LLC will not use or disclose your protected health information without your written authorization. If you or your representative authorizes Christian Servants Home Care Texas, LLC to use or disclose your protected health information, you may revoke that authorization in writing at any time. If you revoke an Authorization, Christian Servants Home Care Texas, LLC will no longer use or disclose your PHI for the purposes covered by that Authorization, except where Christian Servants Home Care Texas, LLC has already relied on the Authorization


YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION

Right to request restrictions. You may request restrictions on certain uses and disclosures of your protected health information. You also have the right to request restrictions on protected health information we disclose about you to a family member, friend or other person who in involved in your care or payment for your care. Christian Servants Home Care Texas, LLC is not required to agree to your request (except that if you are mentally competent, you may restrict disclosures to family members or friends). If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you with emergency treatment. If we do agree to accept your requested restriction, we can stop complying with the restriction upon providing notice to you. However, if you paid out-of-pocket for services in full and do not want us to disclose to your health plan information about services for purposes of payment or health care operations, we must comply with your request. If you wish to make a request for restrictions, please contact the administrator/manager/supervisor of Christian Servants Home Care Texas, LLC at 903-213-2171. You may send your written request through the professional that admitted you to Christian Servants Home Care Texas, LLC or you may mail the request to 101 E. Park Blvd, Ste 600, Rm 40, Plano, TX 75074 or email to [email protected]. Attention: Compliance Officer Right to receive confidential communications. You have the right to request that Christian Servants Home Care Texas, LLC communicate with you in a certain way. For example, you may ask that Christian Servants Home Care Texas, LLC only conduct communications pertaining to your protected health information with you privately with no other family members present. If you wish to receive confidential communications, please contact, in writing, the administrator/manager of Christian Servants Home Care Texas, LLC. Christian Servants Home Care Texas, LLC will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.

Right to inspect and copy your protected health information. You have the right to inspect and obtain a copy of your protected health information, including billing records and other written information that may be used to make decisions about your care (‘your designated record set’), subject to some exceptions. You may also direct us to send a copy directly to a third-party designated by you. Your request must be made in writing to the administrator/manager/supervisor of Christian Servants Home Care Texas, LLC. You may send your written request through the professional that admitted you to Christian Servants Home Care Texas, LLC or you may mail the request. Christian Servants Home Care Texas, LLC may charge a reasonable fee, consistent with applicable law, for our costs in responding to your request. To the extent Christian Servants Home Care Texas, LLC maintains your designated record set electronically, you have the right to receive an electronic copy of such information.

Right to request amendment of your protected health care information. You have the right to request that Christian Servants Home Care Texas, LLC amend your records if you believe that your protected health information is incorrect or incomplete. That request may be made as long as the information is maintained by Christian Servants Home Care Texas, LLC. A request for amendment of records must be made in writing to the administrator/manager/supervisor and must state the reason for the request. Christian Servants Home Care Texas, LLC may deny the request if the information (a) was not created by Christian Servants Home Care Texas, LLC, unless the originator of the information is no longer available to act on you request; (b) is not part of the protected health information maintained by the Christian Servants Home Care Texas, LLC; (c) is not part of the protected health information which you are permitted to inspect and copy; or (d) is already accurate and complete, as determined by Christian Servants Home Care Texas, LLC. You may send your written request through the professional that admitted you to Christian Servants Home Care Texas, LLC or you may mail the request. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and an explanation of your right to submit a written statement disagreeing with denial.

Right to an accounting. You have the right to request an accounting of certain disclosures of your protected health information. An accounting is a listing of disclosures made by Christian Servants Home Care Texas, LLC or by others on Christian Servants Home Care Texas, LLC’s behalf, but does not include disclosures for treatment, payment or health care operations, disclosures made pursuant to your Authorization, and certain other exceptions. The request for an accounting must be made in writing to the administrator/manager/supervisor. Accounting requests may not be made for periods of time in excess of six (6) years. The first accounting provided within a 12-month period will be free. For further accounting requests, Christian Servants Home Care Texas, LLC may charge a reasonable cost-based fee. You may send your written request through the professional that admitted you to Christian Servants Home Care Texas, LLC or you may mail the request. Right to a paper copy of this Notice. You have the right to a separate paper copy of this notice at any time, even if you have agreed to receive this Notice electronically. To obtain a paper copy of the Notice, please request a copy from your care provider.

NOTICE IN LANGUAGE YOU UNDERSTAND

Before services are provided to you, you are entitled to the information in this Notice in a language you understand or can be explained to you by your family. If you are having any difficulty understanding your rights and obligations under the Notice, please tell someone at Christian Servants Home Care Texas, LLC immediately. If we believe you are having difficulty understanding this Notice, we will make every eAort to explain it to you with the assistance of a family member or may enlist the assistance of someone to help translate this Notice so that you understand it.

CHANGES TO THIS NOTICE

Christian Servants Home Care Texas, LLC reserves the right to change the terms of the Notice and to make the revised of new Notice provisions eAective for all protected health information already received and maintained by Christian Servants Home Care Texas, LLC as well as for all protected health information receives in the future. Christian Servants Home Care Texas, LLC will provide a copy of the revised Notice upon request.

FOR FURTHER INFORMATION OR TO FILE A COMPLAINT

If you have any questions regarding this Notice or complaints, please contact Christian Servants Home Care Texas, LLC Privacy Office at 903-213-2171. Christian Servants Home Care Texas, LLC Home has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. Complaints against Christian Servants Home Care Texas, LLC Home can be mailed to 101 E. Park Blvd, Ste 600, Rm 40, Plano, TX 75074, or emailed to [email protected]. Attention: Compliance Officer.

Our Responsibilities

We are required by law to maintain the privacy & security of your information and to let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties & privacy policies in this notice and give you a copy of it. We will not share your information other than as described here.