Privacy Notice

The Care Ahead interest form

The Care Ahead interest form is provided through Zoho Forms. Information entered into the form is transmitted to and stored within Golden Rose Wellbeing's Zoho Forms account so that Golden Rose Wellbeing can review and respond to the request.

Information we collect

Golden Rose Wellbeing collects only the information reasonably needed to understand your request and contact you about Care Ahead:

• Your name, email address, and optional telephone number
• Your Arizona city or ZIP code
• The general type and approximate timing of the healthcare transition
• A brief description of the practical problem you want to organize
• Your acknowledgments concerning age, location, service boundaries, and permission to be contacted
• Communication preferences and accessibility needs you choose to share

Please do not submit Social Security numbers, insurance identification numbers, financial account information, portal passwords, complete medical records, detailed diagnoses, medication lists, test results, or emergency information through the interest form.

How we use information

Golden Rose Wellbeing may use information submitted through the website to:

• Respond to your inquiry
• Decide whether an eligibility conversation may be appropriate
• Schedule or prepare for a requested conversation
• Provide accessibility or communication support
• Maintain a record of your request and our response
• Protect the website, prevent misuse, and comply with legal obligations
• Evaluate interest in Care Ahead using aggregated or de-identified information when feasible

Joining the interest list does not create a client relationship. Golden Rose Wellbeing will not use an interest request as permission to provide clinical care, contact your healthcare professionals, access a patient portal, or obtain medical records.

Health-related information and HIPAA

Some information you choose to submit may concern health or healthcare. Golden Rose Wellbeing treats that information as sensitive. However, information does not become protected health information under the Health Insurance Portability and Accountability Act merely because it concerns health. HIPAA applicability depends on the legal role and relationship of the organizations involved.

This website and the private-pay Care Ahead interest process are not represented as a patient portal or as services provided on behalf of a HIPAA-covered healthcare provider. If Golden Rose Wellbeing later handles protected health information for a covered entity or business associate, the applicable agreement and privacy requirements will govern that activity.

When we may share information

Golden Rose Wellbeing does not sell personal or health-related information. We may disclose information only as reasonably necessary:

• To Zoho Forms and other reviewed vendors that help operate forms, communications, scheduling, document storage, or website hosting
• At your direction or with your permission
• To comply with a law, court order, subpoena, or lawful government request
• To protect a person's safety, prevent fraud or misuse, or defend legal rights when disclosure is permitted or required
• As part of a business reorganization, subject to applicable privacy obligations

Submitting an interest form will not authorize Golden Rose Wellbeing to communicate with your physician, insurer, caregiver, or another third party about you.

Website services and technical information

Our hosting provider and security services may automatically process technical information such as an internet protocol address, browser type, device type, requested pages, date and time, and security events. Golden Rose Wellbeing will not add advertising pixels or use health-related form information for targeted advertising.

The website may load resources needed to display its fonts, logo, or other content. Those providers may receive ordinary connection information such as an internet protocol address. We will review external website resources before publication and limit them when practical.

How we protect and retain information

Golden Rose Wellbeing uses administrative, technical, and organizational safeguards appropriate to the nature of the information and the way it is used. No website, email, or storage system can guarantee complete security.

Golden Rose Wellbeing will ordinarily delete an interest request within 90 days after the request is closed or the last substantive contact, unless the requester becomes a client, asks us to retain it, or a longer period is reasonably needed for a legal, security, or documentation obligation. Test, duplicate, and spam entries may be deleted sooner. Information needed for an accepted client relationship will be handled under the applicable service agreement and client-record retention requirements.

Your choices

You may choose not to submit an interest form. You may ask Golden Rose Wellbeing to correct your contact information, stop contacting you about Care Ahead, or delete an interest request when deletion is not inconsistent with a legal or documentation obligation.

To make a privacy request, email [email protected]. We may need to confirm your identity before completing a request.

Children

The Care Ahead introductory release is intended for adults age 18 or older. The website is not designed to collect personal information directly from children.

Changes to this notice

Golden Rose Wellbeing may revise this notice as its website, service model, vendors, or legal obligations change. The effective date above will identify the current version. Material changes will be presented appropriately before they govern newly collected information.

Contact

Questions about this notice may be sent to [email protected].