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Notice of Privacy Practices

Effective April 14, 2003

This notice describes how personal and health information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.

Our Privacy Commitment to You

We care about your privacy. The information we collect about you is private. We are required to give you a notice of our privacy practices. Only people who have both the need and legal right may see your information. Unless you give us permission in writing, we will only disclose your information for purposes of treatment/services, payment business operations or when we are required by law to do so. If there is ever any breach of unsecured Personal Health Information you will be notified by Senior Services immediately.

Understanding the Type of Information We Have

We get information about you when you receive services through any programs of Senior Services, Inc. It includes your date of birth, sex, ID number and other personal information. We also get bills, reports from your home health service provider, and other data about your services through us.

How We Use and Disclose Your Personal Information

  • Treatment/Services- We may disclose information about you to coordinate your services. For example, we give information to a provider in order for you to receive the services that you have agreed to through your Person- Centered Plan.
  • Payment-We may use and disclose information so the care you get can be properly billed and paid for. For example, we may ask your case manager for details before we pay the bill for your care.
  • Business Operations- We may need to use and disclose information for our business operations. For example, we may use information to review the quality of the services you get. We may use or disclose only your demographic information, as Necessary, in order to contact you for fundraising activities supported by our agency.
  • Exceptions- For certain kinds of records, your permission may be needed even for release for treatment, payment, and business operations.
  • As Required By Law- We will release information when we are required by law to do so. Examples of such release would be for law enforcement or national security purposes, subpoenas or other court orders, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety, or in other kinds of emergencies.
  • With Your Permission- If you give permission in writing, we may use and disclose your personal information. If you give permission, you have the right to change your mind and revoke it. This must be in writing, too. We cannot take back any uses or disclosures already made with your permission.

Your Privacy Rights

You have the following rights regarding the personal information that we have about you.

  • Your Right to Inspect and Copy- In most cases, you have the right to look at or get copies of your records. You may be charged a fee for the cost of copying records.
  • Your Right to Amend- You may ask us to change your records if you feel that there is a mistake. We can deny your request for certain reasons, but we must give you a written reason for our denial.
  • Your Right to a List of Disclosures- You have the right to ask for a list of disclosures made after April 14, 2003. This list will not include the times that information was disclosed for treatment, payment or business operations. This list will not include information provided directly to you or your family, or information that was sent with your authorization.
  • Your Right to Request Restrictions On Our Use Or Disclosure Of Information- You have the right to ask for limits on how your information is used or disclosed. We are not required to agree to such requests.
  • Your Right to Request Confidential Communications- You have the right to ask that we share information with you in a certain way or in a certain place. For example, you may ask us to send information to your work address instead of your home address. You do not have to explain the basis for your request.

Changes to this notice

We reserve the right to revise this notice. A revised notice will be effective for information we already had about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. Any changes to our notice will be published on If the changes are material, a new notice will be mailed to you before it takes effect.

How to Use Your Rights Under this Notice

If you have questions or would like more information, you may contact our Privacy Officer at 269-382-0515

If you believe your privacy rights have been violated, you can file a complaint with Senior Services, Inc. or the Federal Government. You will not be penalized for filing a complaint.

Complaints and Communications to Us You may write to:
Privacy Officer –
Alec Jacobs
Senior Services, Inc.
918 Jasper Street
Kalamazoo, MI 49001
Phone: 269-382-0515
Fax: 269-382-3189
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Complaints to the Federal Government
You may write to:
Office of Civil Rights
Dept. of Health and Human Services
200 Independence Ave, S. W.
Washington, DC 20201
Phone: 866-927-7748
TTY: 886-788-4989
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Copies of this notice

You have the right to receive an additional copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. Please call or write to us to request a copy. This notice is available in other languages and alternate formats that meet the guidelines for the Health Insurance Portability and Accountability Act (HIPAA).

Esta notificacion esta disponible en otras lenguas y formatos diferentes que satisfacen las normas del Health Insurance Portability and Accountability Act (HIPAA).