Consent & disclosures
HIPAA privacy acknowledgment
Harbor & Haven Home Care, LLC is committed to protecting the privacy and confidentiality of client information. Client information will be collected, used, stored, and disclosed only as permitted by applicable federal and state privacy laws and for purposes related to providing requested services, coordinating care, billing, quality improvement, and other legally authorized purposes.
By signing below, I acknowledge that I have received or been offered Harbor & Haven Home Care, LLC’s Notice of Privacy Practices and understand how my information may be used and disclosed.
Electronic communication & cybersecurity notice
Harbor & Haven Home Care, LLC employs reasonable administrative, physical, and technical safeguards designed to protect electronic personal information. However, no electronic communication, computer system, cloud platform, email, text messaging service, or internet transmission can be guaranteed to be completely secure or free from unauthorized access.
To the extent permitted by applicable law, Harbor & Haven Home Care, LLC shall not be liable for cybersecurity incidents, data breaches, ransomware attacks, phishing attacks, third-party technology failures, or unauthorized access that occur despite the implementation of commercially reasonable security safeguards. Nothing in this provision limits any legal responsibilities that cannot be waived under applicable law.
Client financial responsibility
The client and/or financially responsible party agrees to pay all charges for services rendered in accordance with Harbor & Haven Home Care, LLC’s current fee schedule and payment policies. Payment is due as specified in the Service Agreement. Any additional approved services requested beyond the agreed service plan may result in additional charges.
Appointment cancellation policy
A minimum of 24 hours’ advance notice is required to cancel or reschedule a scheduled consultation or service visit.
Appointments cancelled with less than twenty-four (24) hours’ notice may be subject to applicable cancellation fees as outlined in the Service Agreement.
Consultation deposit & no-show policy
A $45 consultation deposit is required to reserve an initial consultation appointment.
If the client or responsible party fails to appear for the scheduled consultation without prior notice (“no-show”), the $45 deposit is non-refundable.
If Harbor & Haven Home Care, LLC cancels the consultation, the deposit will be refunded or applied to a rescheduled appointment, at the client’s choice.
Client acknowledgment
By signing below, I acknowledge that:
- The information provided is accurate to the best of my knowledge.
- I understand that Harbor & Haven Home Care, LLC provides non-medical home care services only and does not provide medical diagnosis, treatment, nursing care, or legal advice.
