The Life Source Center is committed to protecting the privacy and confidentiality of persons it serves. Federal law provides privacy protections for person’s rights with regard to the use and disclosure of personal information. Protected information of person’s includes individually identifiable information such as name, address, age, Social Security number, account number and any other information that persons are asked to provide.

Uses and Disclosures of Privacy Information
In order to share any personal information with other relevant service providers or other pertinent persons, the Life Source Center needs to receive written authorization from persons to do so.  To protect the privacy of such information, the Life Source Center may use or disclose information in certain permissible ways, such as those described below.

  1. To provide the person with best possible services
  2. To provide required information to another organization i.e. providers of health services
  3. To comply with an applicable federal, state or local laws
  4. To report suspected abuse, neglect or domestic violence as required by applicable law.
  5. To report homicidal or suicidal plans to appropriate persons.
  6. To make available to the Department of Health and Human Services in order to demonstrate compliance with HIPAA
  7. To respond to a subpoena, warrant, summons or other legal request as required by law.
  8. To release information for purposes of public safety or national security.
  9. To share certain information with a child placing organization.
  10. To make available to the Department of Children & Family home study and any other material as it relates to an adoption home study and post placement reports.

Authorization for sharing information may be revoked by the person at any time when done in writing. If the person revokes authorization, the Life Source Center will no longer use or disclose such information except to protect the patient or members of the community.

Changes in this notice: The Life Source Center reserves the right to change its’ privacy policy. Amended changes to this privacy policy will be posted within ten business days on the Life Source Center web site. Persons are responsible to periodically reviewing the Life Source Center web site and can request in writing any further restriction on disclosure of personal information. Persons electing to make use of our services and providing personal information are requested to sign this personal privacy policy and e-mail or mail it to the Life Source Center.  After reading, sign and date below.