Long Term Care Referral Privacy Policy & Disclosure
All Long-Term Care Referral Businesses operating in the State of Oregon are required by law to register with
the Department of human Services and provide a list of disclosures to clients as well as additional information
for consumers seeking assistance in finding long-term care options.
Before or at the time of collecting personal information, we will identify the purposes for which information is
being collected.
Mandated Disclosures
Oregon law requires a Long-Term Care Referral Agent to make the following to a client
The types of referrals being provided to you included, but not limited to the following:
Independent
Assisted Living Facility
Memory Care
Residential Care Facility (RCF)
Adult Foster Home
Continuing care Retirement Community (CCRC)
Medicaid Contracted
Referral fees:
Any fees paid to the referral Agent for services will be paid by the admitting home/facility – Yes
The Referral Agents right to a referral fee does not expire if the client does not move in to a referred
facility within a specified period from the time of the referral.
Limitations on referrals:
The client will be referred only to facilities with which the referral agent has a
business-to-business contract: No
Facility Complaint History:
The Oregon Department of Human Services (ODHS) website listing complaints concerning
facilities/care communities is found at: https://ltclicensing.oregon.gov
Additional Information:
The following additional information beyond the mandatory disclosures is provided to assist the consumer in
understanding Oregon laws regarding referrals.
A Referral Agent Must:
1. Discontinue providing services to a client who notified the Referral Agent in writing that the client
no longer whishes to use the services of the Referral Agent has received compensation from the
facility for a referral that has been made, the client may notify the Referral Agent in writing that
he/she wish to use the services of another Referral Agent in the future for referral to another
facility in a subsequent move. The client’s written notice shall identify the name of the facility and
the move-in date of the original referral made by the Referral Agent.
2. Provide the required disclosures to the client in writing in a conspicuous and clear manner. The
disclosure may be made orally first if the agents make an audio recording with the consent of the
client and thereafter provides the client a written disclosure.
A Referral Agent May Not:
1. Provide a referral to a long-term care facility/home for compensation unless registered with
ODHS.
2. Refer a client to a facility in which the Referral Agent or an immediate family member has an
ownership interest.
3. Share a client’s placement information with or sell a client’s placement information to a facility
or marketing affiliate without obtaining affirmative consent from the clients or his/her
authorized representative for each instance of sharing or selling such information.
4. Contact a client or authorized representative who has requested in writing that the Referral
Agent stop contacting them.
Authorization to Share Placement Information
I authorize this Referral Agent to share my placement information with the facilities to which I will be referred
or with this Referral Agent’s marketing affiliates.
_________________________________ _________________
Signature Date
_________________________________ __________________
Signature Date
Privacy Policy
Your privacy is very important to us. Accordingly, we have developed these Policy in order for you to
understand how we collect, use, communicate and disclose and make use of personal information.
The following outlines our privacy policy.
- Before or at the time of collecting personal information, we will identify the purposes for which information
is being collected. - We will collect and use personal information solely with the objective of fulfilling request from clients
for the sole purposes specified to the client in the referral contract and for other compatible purposes,
unless we obtain the consent of the individual concerned or as required by law - We will only retain personal information as long as necessary for the fulfillment of those purposes.
- We will collect personal information by lawful and fair means and, where appropriate, with the
knowledge or consent of the individual concerned. - Personal data should be relevant to the purposes for which it is to be used, and, to the extent
necessary for those purposes, should be accurate, complete, and up-to-date. - We will protect personal information by reasonable security safeguards against loss or theft, as well as
unauthorized access, disclosure, copying, use or modification. - We will make readily available to customers information about our policies and practices relating to
the management of personal information. - We are committed to conducting our business in accordance with these principles in order to ensure
that the confidentiality of personal information is protected and maintained.