Clients

NW Senior Advisors, Inc. Disclosure of Services and Release

NW Senior Advisors, Inc. ('NWSA') is a senior housing and care provider referral agency mandated under the ELDER AND VULNERABLE ADULT REFERRAL AGENCY ACT Chapter 18.330 RCW. As a client of NWSA; you, your family and representatives have the right to a disclosure statement. NWSA does not charge a fee to their clients or representatives for referral services and are paid directly by the senior housing and care provider. NWSA does not charge referral placement fees for assisting families with placements where Medicaid is the payer source. NWSA make referrals and offer options to their clients and do not make direct recommendations.
- NWSA's senior housing and care provider referral services are always free to our clients and their families or representatives. We do not require or request clients to sign waivers of potential liability for losses of personal property or injury. Also, we do not ask for waivers of any rights of the client be signed.
- NWSA works with the client, care service facilities and supportive housing providers. We will inform the providers with details regarding the potential clients housing and care needs. In order to do so, NWSA must obtain authorization to disclose confidential health care information and information identifying the client.
- We typically conduct routine visits of the senior housing provider facilities we refer our clients to at minimum annually. During the referral process NWSA will inform our clients in writing or by electronic means when the property has been previously toured, DSHS website enforcement letter findings and date checked.
- The client may without cause stop using NWSA services or switch to another agency without penalty or cancellation fee to the client or representative.
- A client may file a complaint of violations with the Attorney General’s office.
Attorney General Phone: Mon-Fri, 10am to 3pm, 360-753-6200 Office of the Attorney General, 1125 Washington Street SE, PO Box 40100, Olympia, WA 98504-0100
- We receive fees from the senior housing or care providers for making referrals. This fee is based on an agreement that NWSA and the provider have agreed upon. The fee ranges from 30%-100% of one month's equivalent rent and care charges for permanent, respite and hospice placements.

NWSA's contracts with senior housing and care providers state the fee cannot be passed on to the client. Payment terms are due anywhere from 10-30 days after client has begun services with the provider. We will provide a pro-rated refund to the provider if the client passes away or moves out within 60 days at a 30% rate based on number of days services were provided.

Client authorization to release information:
- I give permission for NW Senior Advisors, Inc. to discuss the health and care needs of the client listed above for the purpose of senior housing and care services referrals.
- I authorize them to review and discuss records and health care information from to and with any long-term care facility, hospital, physician, skilled nursing facility or other health care providers and/or staff associated.
- I also authorize NW Senior Advisors, Inc. and any of their associates same ability and permission to review and discuss records.
- I agree and understand that such information may be shared via email, fax, telephone calls, electronic mailings and care planning meetings.
- The authorization of this disclosure may change with the written notification of the client or their representatives.
- A printed version, photocopy, electronic mailing, website agreement and/or fax shall be valid as original.

NW SENIOR ADVISORS , INC.
PO BOX 7083 - BONNEY LAKE, WA 98391

F: 253-251-3281
TOLL FREE: 1-866-307-0596
E: CINDIEB@NWSENIORADVISORS.COM

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