1. Purpose of This Policy

 

Team Senior Referral Services is committed to protecting the privacy and confidentiality of our clients. This Privacy Policy explains how we collect, use, communicate, disclose, and safeguard your personal information in accordance with applicable Oregon laws.

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2. Why We Collect Personal Information

 

Before requesting any personal information, we will clearly explain why the information is needed. Personal information is collected solely to:

• Identify appropriate long-term care placement options

• Assist with referral services tailored to your needs

• Coordinate with prospective care providers

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3. Consent and Authorization

 

In compliance with OAR 411-054 requirements, prior to collecting or sharing your information:

• you will be provided with a Disclosure and Advisory Form and a Privacy Statement

• We will obtain your affirmative consent, via our ‘Authorization To Obtain and Release Healthcare Information” form, before sharing your personal information

• Your information will not be shared without your knowledge and permission

 

4. How Information Is Collected

 

We collect personal information:

• By lawful and fair means

• With your knowledge and consent

• Directly from you, your family, or authorized representative(s)

 

This aligns with Oregon consumer protection and privacy expectations under ORS Chapter 646 (Unlawful Trade Practices Act).

 

5. Use and Disclosure of Personal Information

 

Your personal information:

• Will only be used for referral and placement purposes

• Will only be shared with long-term care facilities or providers to which you are being referred to

• Will not be disclosed to unrelated third parties without your consent, unless required by law

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6. Accuracy of Information

 

We take reasonable steps to ensure that your personal information is:

• Accurate / Complete / Current

 

You may request updates or corrections at any time.

 

7. Protection of Personal Information

 

We maintain appropriate safeguards to protect your personal information against:

• Loss or theft

• Unauthorized access

• Disclosure

• Copying, use, or modification

 

8. Client Rights and Requests

 

You have the right to:

• Request access to your personal information

• Request corrections or updates

• Ask how your information has been used or shared

• Terminate our use of your information at any time

 

We will respond in a timely and professional manner in accordance with Oregon laws.

 

9. Retention of Information

 

• Signed Disclosure and Advisory Forms are retained for a period of three (3) years, consistent with OAR 411-054 recordkeeping expectations.

• Sensitive information, including health and financial details, is not retained longer than necessary to provide referral services.

 

By signing below, I, (printed name) ________________________________________, acknowledge that I have received a copy of this policy and has been reviewed with me by a representative of Team Senior Referral Services. I understand how my personal information will be collected, used, stored, and disclosed and I consent to such practices as described in the policy. I understand that I may contact Team Senior with any questions regarding this policy.

 

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Client / Client Representative Signature

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Date

 

* This form will be retained in Client’s Hard Chart for a minimum of 3 years.
** Last revision of this policy: 5/4/2026