Client Privacy and Confidentiality Notice

Acts of Service Home Care LLC

Hockley, TX 77447
Effective Date: June 1, 2026
Revised: September 19, 2026

Our Commitment to Your Privacy

Acts of Service Home Care LLC respects your privacy and protects the confidentiality of your personal, health and service information. This notice explains how we handle that information, respond to your requests and address privacy concerns.

We follow applicable Texas privacy laws, personal assistance services confidentiality requirements and other laws governing the information we maintain. Nothing in this notice limits your legal rights.

Information We Collect

We collect information needed to arrange and provide your services, including:

• Your name, contact information and emergency contacts.

• Relevant health conditions, medications and assistance needs.

• Assessments, individualized service plans and caregiver notes.

• Service schedules, payment arrangements and billing records.

• Authorizations and information about your legally authorized representative.

How We Use and Share Information

We use information for the purposes below and obtain your authorization whenever required by law.

Providing services: To assess your needs, develop your service plan, assign caregivers and document assistance provided.

Coordinating care: To communicate with people involved in your services when you authorize sharing or another lawful basis permits it.

Billing and administration: To prepare client invoices, receive payments, maintain records, supervise staff, provide training and review service quality. We do not currently bill insurance, submit insurance claims or accept Medicaid.

Required reporting and oversight: To make legally required reports, including reports of suspected abuse, neglect or exploitation, and cooperate with authorized regulatory inspections or investigations.

Emergencies and legal requests: To provide information when permitted or required for an emergency, safety concern or valid legal process. We evaluate requests before releasing information; a request alone does not automatically authorize disclosure.

We may disclose protected health information electronically when authorized or otherwise permitted by applicable law. We use appropriate safeguards and obtain any required authorization before disclosure.

Family Members and Authorized Representatives

A family relationship alone does not automatically authorize access to your information.

You may identify the people with whom we may communicate and the information we may share. We verify a representative’s legal authority before allowing that person to act for you.

Tell us when your preferences or representative change. When you cannot communicate your wishes, we share information only when a lawful basis permits it.

Your Permission and Choices

We obtain written authorization for disclosures requiring it, including applicable uses of information for marketing. This notice does not authorize the sale of your health information or its use in advertising.

You may withdraw an authorization by contacting the Privacy Officer in writing. Withdrawal generally does not undo actions already taken in reliance on the authorization or prevent disclosures required by law.

Records subject to additional confidentiality protections are handled according to those requirements. Receiving a record from another provider does not give us unrestricted permission to share it.

Access, Corrections and Communication Requests

Contact the Privacy Officer for assistance with any request.

Access to records: You may ask to review or obtain copies of your records, subject to applicable legal exceptions. We verify identity and authority, explain any permitted fees and respond within the applicable timeframe. Where the Texas electronic-health-record requirement applies, we provide records within 15 business days after a written request.

Corrections: You may request correction of information you believe is inaccurate or incomplete. We review the request and explain any denial and applicable options for documenting disagreement.

Confidential communications: You may ask us to use a particular telephone number, mailing address or other reasonable communication method. We discuss how to accommodate your request.

Limits on sharing: You may request additional limits on information sharing. We explain whether we can agree and honor restrictions required by law. A request cannot prevent legally required reporting.

Copy of this notice: You may request a paper or electronic copy at any time.

How We Protect Your Information

We maintain safeguards for paper and electronic records, train staff on confidentiality and limit access according to job responsibilities.

Outside service providers who handle client information must have appropriate confidentiality protections. Staff may not access, discuss or disclose client information for personal reasons.

We investigate suspected improper access, use or disclosure. When notification is legally required, we notify affected individuals and appropriate authorities within the required timeframes.

Privacy Questions and Complaints

Chauntevia Nicholson
Administrator and Privacy Officer

Nicole Solis, RN
Alternate Administrator and Backup Privacy Contact

Acts of Service Home Care LLC
Hockley, TX 77447
Office: 346-200-9886
Email: info@actsofservicehomecare.com
Office hours: Monday-Friday, 9:00 AM-4:00 PM
After hours: 346-645-0447 or 936-419-2078

You may raise a concern verbally or in writing. Describe what happened and how we can reach you. If your concern involves one privacy contact, you may contact the other.

Avoid sending unnecessary sensitive information through ordinary email. Ask us about an appropriate way to provide supporting records.

We will not retaliate against you for making a complaint or exercising your rights. You do not have to complete our internal process before contacting a state agency.

Texas HHSC Complaint and Incident Intake

• Phone: 1-800-458-9858

• Email: ciicomplaints@hhs.texas.gov

• Mail: Texas Health and Human Services Commission, Complaint and Incident Intake, P.O. Box 149030, Austin, TX 78714-9030

Texas Attorney General

You may also report concerns about unlawful use or disclosure of health information through the complaint options on the Texas Attorney General’s Patient Privacy page.

Changes to This Notice

We may revise this notice to reflect changes in our practices or applicable law. Revised notices will show a revision date and be available upon request.

Changes cannot override legal protections or replace authorizations required by law. We provide additional notice or obtain authorization when required.

Acknowledgment of Receipt

Please reply to the email delivering this notice at info@actsofservicehomecare.com using the following wording:

“I acknowledge receipt of the Acts of Service Home Care LLC Client Privacy and Confidentiality Notice, revised September 19, 2026.

Client name: ____________________
Date received: ____________________
Name of person replying: ____________________
Relationship or authority, if applicable: ____________________”

Your reply confirms receipt only. It does not authorize additional disclosures, waive your rights or replace separate consent for services.

If you cannot reply by email, contact the office for assistance or another way to document receipt. We retain the acknowledgment, or documentation of delivery and our efforts to obtain acknowledgment, in your client record.