Client’s Rights / Responsibilities
& Privacy Notice

As a client of our agency, we want you to fully understand your rights and responsibilities. We urge you to read the following information so that we may have an enjoyable and productive relationship. If you have any questions or concerns, call us at 508-949-6640 or 1-800-286-6640.

1. To receive care management without discrimination based on age, disability, gender, race, religion, sexual orientation, or source of payment.

2. To be treated with courtesy and respect and to be assured of respect for your property.

3. To be served by individuals who are competent and properly trained.

4. To be fully informed in writing of:

a. your proposed service plan, including the name of the contracted provider agency and the amount of service
to be provided.

b. any changes that will be due through the Home Care
cost sharing program.

c. the procedures to follow if you feel that your rights
have been violated.

5. To be a participant with Tri-Valley staff in the development and
updating of your service plan.

6. To refuse all or part of your service plan.

7. To be assured confidential treatment of personal, financial, and
medical information, and to approve OR refuse release of this
information to any individuals outside of Tri-Valley, except as
required by law or by contract.

8. To voice grievances regarding care management policies free from reprisal by Tri-Valley.

1. To be home at the mutually agreed upon time to meet with your
care manager. Periodic visits are necessary to evaluate your
ongoing service needs.

2. To be home at the mutually agreed upon time to allow direct care workers to carry out their duties. Direct care workers are authorized to do specific tasks in accordance with your service plan.

3. To communicate with your care manager when you can anticipate that you will not be home to receive services.

4. To be prompt with monthly co-payments, and to notify your care manager if you are having financial difficulties.

5. To provide accurate and complete information to care managers.

6. To be honest in discussing your home care needs. The care manager must ask you some personal questions regarding your health status in order to determine your continued eligibility for services and develop the most appropriate service plan.

7. To notify your care manager if services are not delivered as stated in your service plan.

8. To treat the Tri-Valley staff with courtesy and respect.

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Tri-Valley, Inc. Privacy Practices Notice

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

• Tri-Valley, Inc. is required by law to protect the privacy of its clients. It will keep confidential any and all client healthcare information and will provide clients with a list of duties or practices that protect confidential healthcare information.

• Your confidential healthcare information may be released to professionals within the organization for the purpose of providing you with quality home care services, for operations and for billing.

• Your confidential healthcare information may be released to the Executive Office of Elder Affairs, the Division of Medical Assistance, our business associates, or your insurance provider for the purpose of the organization receiving payment for providing you with needed home care services.

• Tri-Valley may use or disclose information to notify your family members, personal or legal representatives, other persons responsible for your care, information relevant to that person’s involvement in your care or payment related to your care.

Your confidential healthcare information may be released:

• When required by law or in response to a valid subpoena.

• When requested by someone who has the legal right to act for you.

• To oversight, funding and quality assurance agencies.

• To other healthcare providers in the event you need emergency care.

• A public health organization or federal organization in the event of a communicable disease.

• To avoid a serious threat to a person’s safety.

• For approved research when the personal information cannot be used to identify you.

• When requested by the U.S. Department of Health and Human services to make sure that your privacy is protected.

• To public or law enforcement officials in the event of an investigation in which you are a victim of abuse, crime or domestic violence.

Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.

• Except as described in this notice, confidential healthcare information may be released only after receiving written authorization from you. You may revoke your permission to release confidential healthcare information at any time.

• You may be contacted by Tri-Valley to remind you of any appointments, home care options, benefits for which you might qualify or other health services that may be of interest to you or for the purpose of raising funds to support the organization’s operations.

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• To review and photocopy any/all portions of your home care record (at your expense).

• To have your healthcare information amended if you believe it is wrong or incomplete and Tri-Valley agrees. If Tri-Valley disagrees, you may add a statement of disagreement to your statement.

• To know who has accessed your confidential healthcare information and when and for what purpose.

• To possess a copy of this Privacy Practices Notice.

• To request communication of your health information by alternative means at alternative locations.

• Restrict the use of your confidential healthcare information. However, Tri-Valley may choose to refuse your restriction if it is in conflict with providing you quality home care or in the event of an emergency situation.
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Tri-Valley will abide by the terms of this notice. We reserve the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. Clients will receive a mailed copy of any changes to this notice within 60 days of making the changes.

You have the right to complain to the organization if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to the organization:

ATTN: Marilyn Travinski, Executive Director
Tri-Valley, Inc.
10 Mill Street
Dudley, MA 01571

All complaints will be investigated. Filing a complaint or exercising your rights will not affect your Home Care services. You may also complain to the U.S. Secretary of Health and Human services.
For further information about this Privacy Notice, please contact:

Anna Bellows
Privacy Officer
1-800-286-6640 or 508-949-6640 or TTY 508-949-6654

Click here for Website Privacy Policy

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