AVA HomeCare, LLC: Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This notice describes how health information about you may be used and shared, and how you can get access to this information. Please review it carefully.

Effective date: The date this notice is first posted on our website: [launch date]

AVA HomeCare, LLC ("AVA", "we", "us") is a licensed Class B non-medical home care agency in Colorado, serving clients since 2014. We help with personal care, homemaking and other daily tasks in your home. This notice applies to the health information we keep about you as an AVA client, on paper and electronically.

Questions about this notice, or to use your rights, contact our Privacy Officer:

Tatsiana Tarasava, Founder & Administrator

AVA HomeCare, LLC · 2600 S Parker Rd, Bldg 3, Ste 237, Aurora, CO 80014

Phone 720.937.1500 · Fax 1.877.599.3906 · Email info@avahomecare.com

Deaf, hard of hearing or speech disability: call Relay Colorado at 711.

Summary

Your rights

You have the right to:

Get a copy of your paper or electronic record
Ask us to correct your record
Ask us to contact you in a confidential way
Ask us to limit the information we use or share
Get a list of those with whom we've shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated

➤ See "Your Rights" below for more information on these rights and how to use them.

Your choices

You have some choices in the way we use and share information as we:

Tell family and friends about your condition and care
Provide disaster relief
Market our services or sell your information (we never do either without your written permission, and we don't sell information)
Raise funds (AVA does not do this)

➤ See "Your Choices" below for more information on these choices and how to use them.

Our uses and disclosures

We may use and share your information as we:

Provide your care
Run our organization
Bill for your services
Help with public health and safety issues
Do research (the law allows this, but AVA does not do it)
Comply with the law
Respond to organ and tissue donation requests
Work with a medical examiner or funeral director
Address workers' compensation, law enforcement and other government requests
Respond to lawsuits and legal actions

To the extent that we have your substance use disorder patient records, subject to 42 CFR Part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

➤ See "Our Uses and Disclosures" below for more information.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. To use any of these rights, contact our Privacy Officer (see the top of this notice). We may ask you to make some requests in writing.

Get an electronic or paper copy of your record

You can ask to see or get an electronic or paper copy of your client record and other health information we have about you, such as your care plan, visit notes and visit records. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee as allowed by HIPAA. Electronic copies sent by email are free.

Ask us to correct your record

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home phone, cell phone, email or text) or to send mail to a different address.
We will say "yes" to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for your care, for payment or for our operations. We are not required to agree, and we may say "no", for example, if it could affect your care. If we agree, we may still share the information if you need emergency treatment.
If you pay for a service out of pocket in full, you can ask us not to share information about that service with your health insurer for payment or our operations. We will say "yes" unless a law requires us to share it.

Get a list of those with whom we've shared information

You can ask for a list (an "accounting") of the times we've shared your health information for the six years before the date you ask, who we shared it with, and why.
The list will include all disclosures except those for care, payment and our operations, and certain other disclosures (such as any you asked us to make). We'll provide one list a year for free, but we may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will give you a paper copy promptly.

Choose someone to act for you

If someone has legal authority to act for you as your personal representative, for example under a medical power of attorney or as your legal guardian, that person can use your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting our Privacy Officer (see the top of this notice).
You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/hipaa/filing-a-complaint.
We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and the choice to tell us to:

Share information with your family, close friends or others involved in your care or in paying for your care
Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

Marketing purposes
Sale of your information (AVA does not sell personal information)
Most sharing of psychotherapy notes (AVA provides non-medical care and does not keep psychotherapy notes)

Fundraising:

AVA does not raise funds and does not use your health information for fundraising. If that ever changes, we will update this notice first, and you can tell us not to contact you for fundraising.
If we have your substance use disorder patient records, subject to 42 CFR Part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.

Text messages: AVA does not send marketing text messages, and it does not send caregiver-arrival text messages. We may call or text you about scheduling and your visits; you can ask us to contact you a different way (see "Request confidential communications").

Our Uses and Disclosures

How do we typically use or share your health information?

Provide your care

We can use your health information and share it with others who are involved in your care.

Example: Your caregiver and supervisor use your care plan to know what help you need. We may talk with your doctor, nurse, home health agency or Medicaid case manager about your care.

Run our organization

We can use and share your health information to run our agency, improve your care and contact you when necessary.

Example: A supervisor reviews your care plan and visit notes to check the quality of your care. We use your information to schedule your caregivers.

Bill for your services

We can use and share your health information to bill and get payment from Health First Colorado (Colorado Medicaid), your long-term care insurance company or others who pay for your care.

Example: We send information about your visits to Health First Colorado so it will pay for your services.

Companies that help us (business associates)

Some services are done for us by other companies. Examples are the State of Colorado's electronic visit verification (EVV) system, run for the State by Sandata, which records when visits start and end, and companies that provide our agency software, payroll, email, IT and compliance consulting services. These companies may see your information only to do this work for us, and they must protect it by contract and by law.

How else can we use or share your health information?

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR Part 2, we cannot use or share information in those records in civil, criminal, administrative or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

Help with public health and safety issues

We can share health information about you for certain situations, such as:

Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, exploitation or domestic violence (for example, to Colorado Adult Protective Services, as Colorado law requires)
Preventing or reducing a serious threat to anyone's health or safety

Do research

AVA does not take part in health research and does not use or share your information for research. The law would allow it only under strict conditions (for example, approval by a research review board); we would update this notice before doing so.

Comply with the law

We will share information about you if state or federal laws require it, including with the U.S. Department of Health and Human Services if it wants to see that we're complying with federal privacy law, and with the Colorado Department of Public Health and Environment and the Colorado Department of Health Care Policy and Financing (Health First Colorado) for licensing, audits and visit verification.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner or funeral director when a person dies.

Address workers' compensation, law enforcement and other government requests

We can use or share health information about you:

For workers' compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions, such as military, national security and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on our website.

Other information

We never sell personal information, and we never use it for marketing without your written permission.
Colorado law: [confirm with counsel: any Colorado law that sets stricter limits on sharing than HIPAA and applies to AVA, for example rules on HIV or other communicable-disease information, or on records from mental health or substance use treatment. If none applies, delete this line.]
Other formats and languages: this notice is available in large print and in other languages on request, free of charge. Call 720.937.1500 (Relay Colorado 711).
Where to find this notice: in our office at 2600 S Parker Rd, Bldg 3, Ste 237, Aurora, and on our website at avahomecare.com/privacy-practices.

Effective date of this notice: The date this notice is first posted on our website: [launch date]

Version: 1.0, draft prepared October 4, 2026