The Life Source Center is committed to protecting the privacy and confidentiality of persons it serves. Federal law provides privacy protections for person’s rights with regard to the use and disclosure of personal information. Protected information of person’s includes individually identifiable information such as name, address, age, Social Security number, account number and any other information that persons are asked to provide. It also includes protection of personal information through adherence to fair electronic information practices.

Though this Patient Privacy Policy is a long and detailed document, persons are urged to read it in its entirety. Signature of understanding is requested and can be revoked at any time in writing. Revocation is binding unless the Life Source Center staff has taken action in reliance on it, if there are obligations imposed by health insurers in order to process or substantiate claims made under the policy or if the patient has not satisfied any financial obligations incurred.

In order to share any personal information with other relevant service providers or other pertinent persons, the Life Source Center needs to receive written authorization from persons to do so.

Uses and Disclosures of Privacy Information
In order to protect the privacy of such information, the Life Source Center not only guards the physical security of such information, but also limits the way it is used and disclosed to others. The Life Source Center may use or disclose information in certain permissible ways, such as those described below.

1. To best provide the person with best possible services
2. To provide required information to another organization i.e.USCIS
3. To comply with an applicable federal, state or local laws
4. To report a suspected case of abuse, neglect or domestic violence as permitted or required by applicable law.
5. To provide information for public health reasons, including to a public health authority for the prevention or control of disease, injury or disability.
6. To make available to the Department of Health and Human Services in order to demonstrate compliance with HIPAA
7. To respond to a subpoena, warrant, summons or other legal request as required by law.
8. To release information for purposes of public safety or national security.
9. To share certain information with another pre-placement, post-placement or home study organization selected and given written permission to contact.

Other Uses and Disclosures of Privacy Information
Therefore the Life Source Center discloses Privacy information for any purpose than as described above, it must obtain the person’s written authorization. Authorization may be revoked by the person at any time when done in writing. If the person revokes authorization, the Life Source Center will no longer use or disclose such information except as described above. However, the Life Source Center cannot retrieve any information disclosed to a third party in reliance on person’s prior authorization.

Person’s Rights
1. The right to request restrictions: Persons may submit a written request on the
use and disclosure of said information to the Executive Director. The request must specify the information the person wishes to limit, how the person wants the Life Source Center to limit the use and to whom the person may want the restrictions to apply.
2. The right to obtain a copy of personal information: Persons have a right to review and obtain a copy of information that is contained in records that the Life Source Center maintains. However, the Life Source Center will not relinquish records created in anticipation of a civil, criminal or administrative action or proceeding. Access is also not available to persons if records are deemed likely to endanger the life or physical safety of the person or someone else or that the record makes reference to another person and that access would likely cause substantial harm to the other person.
3. The right to amend personal information: Persons have the right to request an amendment of personal information if said patients believe the information the Life Source Center has noted is deemed incorrect or incomplete.
4. The right to file a complaint: If a person believes his or her rights have been violated, Life Source Center staff should be notified immediately in writing.

The Life Source Center policy and federal law prohibit retaliation against any person for filing such a complaint.

Changes in this notice: The Life Source Center reserves the right to change its’ privacy policy. Prior to any notified change, a review and vote of acceptance by the Board of Directors is necessary. Amended changes to this privacy policy will be posted within ten business days on the Life Source Center web site. Persons are responsible to periodically reviewing the Life Source Center web site and can request in writing any further restriction on disclosure of personal information. Persons electing to make use of our services and providing personal information are requested to sign this personal privacy policy and e-mail or mail it to the Life Source Center.

Contact Us >>