HIPAA Notice of Privacy Practices

Lakeshore Woods Senior Living | Goforth Group LLC | Effective: July 1, 2026 | Last Reviewed: July 1, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Who Is Covered by This Notice

This notice applies to the Michigan Cognitive Recovery Center (MCRC) at Lakeshore Woods Senior Living, a service of Goforth Group LLC, located at 4851 Lakeshore Rd, Fort Gratiot, MI 48059. MCRC is a covered health care component under the Health Insurance Portability and Accountability Act (HIPAA).

Our Responsibilities

We are required by law to:

•  Maintain the privacy of your protected health information (PHI)

•  Provide you with this notice of our legal duties and privacy practices

•  Follow the terms of this notice currently in effect

•  Notify you following a breach of your unsecured PHI

How We May Use and Disclose Your PHI

•  Treatment: We may use and share your PHI with physicians, care coordinators, Apollo Health practitioners, and other health care providers involved in your ReCODE+ program. For example, we may share your assessment results with your referring neurologist or primary care physician.

•  Payment:MCRC is a private-pay program. We may use your PHI as needed to process private-pay billing, invoices, payments, deposits, refunds, or other payment-related administration for services you receive at MCRC.

•  Health Care Operations: We may use your PHI for quality improvement, staff education, program evaluation, and business operations directly related to your care.

•  Business Associates: We share PHI with vendors and partners (including Apollo Health) who perform services on our behalf. Each is required to sign a Business Associate Agreement protecting your information.

Other Permitted Uses and Disclosures

We may use or disclose your PHI without your authorization when required or permitted by law, including for:

•  Public health activities and disease reporting

•  Reports of abuse, neglect, or domestic violence to authorized agencies

•  Judicial and administrative proceedings, including in response to a court order

•  Law enforcement purposes as permitted by law

•  Serious and imminent threats to the health or safety of a person or the public

•  National security and intelligence activities as required by law

Uses Requiring Your Written Authorization

We will not use or disclose your PHI for the following purposes without your written authorization:

•  Marketing communications

•  Sale of your PHI

•  Most uses of psychotherapy notes

•  Any other use or disclosure not described in this notice

You may revoke a written authorization at any time, except to the extent we have already acted on it.

Your Individual Rights

•  Right to Access: You have the right to inspect and receive a copy of your PHI maintained in our records. Submit a written request to our Privacy Officer. We will respond within 30 days.

•  Right to Request Amendment: You may request that we correct or add to your PHI if you believe it is inaccurate or incomplete.

•  Right to an Accounting of Disclosures: You may request a list of disclosures of your PHI that we made for purposes other than treatment, payment, and health care operations.

•  Right to Request Restrictions: You may ask us to limit how we use or share your PHI. We are not required to agree except in the limited case where you request restriction of disclosures to a health plan for services you paid for in full.

•  Right to Confidential Communications: You may request that we contact you using a specific address, phone number, or other means.

•  Right to a Paper Copy: You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.

•  Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer (see below) or with the U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/ocr. You will not be penalized for filing a complaint.

Privacy Officer Contact

Nmae: Angela (Licensee)

Michigan Cognitive Recovery Center at Lakeshore Woods Senior Living

Address: 4851 Lakeshore Rd, Fort Gratiot, MI 48059

Phone: (810) 385-3185

Email:[email protected]

Changes to This Notice

We reserve the right to change the terms of this notice. If we make material changes, the revised notice will apply to PHI we already hold as well as PHI we create or receive in the future. We will post the current notice on our website and make paper copies available upon request.