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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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I acknowledge and authorize
✔
I consent to the collection of my consumer health data.*
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I consent to the sharing of my consumer health data with qualified home care agencies.*
*If I am consenting on behalf of someone else, I have the proper authorization to do so. By clicking Get My Results, you agree to our Privacy Policy. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our Terms of Use. for information about our privacy practices.
Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
Share a few details and we will match you to trusted home care in your area:
Checklists and Articles are these Free of do they require paid membership in SafelyMD ?
Terrific Option, reasonable costs
We belong to MedicAlert_SafeReturn caregivers service 800 432 5378 they maintain a records database.
If an individual with Alzheimer's or a related dementia wanders and becomes lost, caregivers can call the 24-hour emergency response line (1.800.625.3780) to report it.
A community support network will be activated, including local Alzheimer Association chapters and law enforcement agencies, to help reunite the person who wandered with the caregiver or a family member. With this service, critical medical information will be provided to emergency responders when needed.
It has the advantage of the subscriber wearing a Medical Alert ID Bracelet with key information engraved on the back. MedicAlert + Alzheimer's Association Safe Return is NOT free
we also use Smat911 service They provided details and data on my family and our home. The emergency needs are displayed at Framingham emergency center if someone calls 911 from our phone.
Great information!!! We created a tool to help families do this for themselves and loved ones. It's called SafelyMD (SafelyFiled for many family members). It provides the ability to capture information, download to paper or be made immediately via an emergency data card if needed; so you have it everywhere you go in your wallet. In addition, a digital copy of your living will, do not resuscitate order or health care power of attorney can be uploaded for immediate access if ever needed. The need to help our elderly parents is growing..especially regarding record keeping and prescription drug management.
I routinely use the following HIPAA. Some services require their own form be used. I you don't have a HIPAA you are blocked out. POA or No Poa. -- HIPAA Privacy Authorization Form and Notice of POA/DPOA Authorization for Use or Disclosure of Protected Health Information (Required by the Health Insurance Portability and Accountability Act, 45 C.F.R. Parts 160 and 164)
{Names and DOB} Do authorize {Name of Party being given authirization} to disclose the protected health information described below to { name that can be given information}
This authorization for release of of our complete insurance, and prescription information. Including all past, present, and future periods.
This medical information may be used by the person we authorized to receive this information for medical treatment or consultation, billing or claims payment, or other purposes as we may direct.
This authorization shall be in force and effect until canceled by named individual at which time this authorization for that individual expires.
We understand that we have the right to revoke this authorization, in writing, at any time. We understand that a revocation is not effective to the extent that any person or entity has already acted in reliance on our authorization or if our authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim.
We understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law.
-- I found grist of this disclaimer on TechByter Worldwide. {adapted for my postings} Regarding my posts: I participate and post for informational purposes only. I assume no responsibility for accuracy. Any actions you take based on my posting information are entirely at your own risk. Products and services are mentioned for informational purposes only and their various trademarks and service marks are the property of their respective owners. I am an independent un-paid aggregator; I collect information from various Internet sources share it thru Dave Mainwaring’s Knowledge Network
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One of our advisors will contact you soon to connect you with trusted sources for care in your area.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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10 Tips for Organizing an Older Adult's Medical Care
Terrific Option, reasonable costs
We belong to MedicAlert_SafeReturn caregivers service 800 432 5378 they maintain a records database.
If an individual with Alzheimer's or a related dementia wanders and becomes lost, caregivers can call the 24-hour emergency response line (1.800.625.3780) to report it.
A community support network will be activated, including local Alzheimer Association chapters and law enforcement agencies, to help reunite the person who wandered with the caregiver or a family member. With this service, critical medical information will be provided to emergency responders when needed.
It has the advantage of the subscriber wearing a Medical Alert ID Bracelet with key information engraved on the back.
MedicAlert + Alzheimer's Association Safe Return is NOT free
we also use Smat911 service They provided details and data on my family and our home. The emergency needs are displayed at Framingham emergency center if someone calls 911 from our phone.
I you don't have a HIPAA you are blocked out. POA or No Poa.
--
HIPAA Privacy Authorization Form and Notice of POA/DPOA
Authorization for Use or Disclosure of Protected Health Information
(Required by the Health Insurance Portability and Accountability Act, 45 C.F.R. Parts 160 and 164)
{Names and DOB}
Do authorize {Name of Party being given authirization} to disclose the protected health information described below to { name that can be given information}
This authorization for release of of our complete insurance, and prescription information. Including all past, present, and future periods.
This medical information may be used by the person we authorized to receive this information for medical treatment or consultation, billing or claims payment, or other purposes as we may direct.
This authorization shall be in force and effect until canceled by named individual at which time this authorization for that individual expires.
We understand that we have the right to revoke this authorization, in writing, at any time. We understand that a revocation is not effective to the extent that any person or entity has already acted in reliance on our authorization or if our authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim.
We understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law.
X______________________ X_________________
http://www.hhs.gov/hipaafaq/use/478.html
The Privacy Rule does not require that a document be notarized or witnessed.
--
I found grist of this disclaimer on TechByter Worldwide. {adapted for my postings}
Regarding my posts: I participate and post for informational purposes only. I assume no responsibility for accuracy. Any actions you take based on my posting information are entirely at your own risk. Products and services are mentioned for informational purposes only and their various trademarks and service marks are the property of their respective owners. I am an independent un-paid aggregator; I collect information from various Internet sources share it thru Dave Mainwaring’s Knowledge Network