We will share medical information about you with each other as necessary to carry out the services as described in the client service plan and, with your consent, for payment or our home services operations. We use and disclose medical information about you for a number of different purposes. Each of those purposes is described below:

• For Treatment
  

  We may use medical information about you to provide, coordinate, or manage your home services care and other related services provided by both us and other health care providers. We may disclose medical information about you to doctors, nurses, hospitals, and other health facilities that become involved in your care. We may consult with other health care providers concerning you and as part of the consultation share your medical information with them. Similarly, we may refer you to another health care provider and as part of the referral share medical information about you with that provider. For example, we may conclude you need to receive services from a physician with a particular specialty. When we refer you to that physician, we will also contact that physician's office and provide medical information about you to them so they have the information they need to provide you with services.

• For Payment
  

  With your consent, we may use and disclose medical information about you so we can be paid for the services we provided to you. This can include billing you, your insurance company, or a third party payor. For example, if your insurance will pay for our services, we may need to give your insurance company information about the home services provided to you so your insurance company will pay us for those services or reimburse you for the amounts you have paid. We also may need to provide your insurance company for a government program, such as Medicare or Medicaid, with information about your medical condition and the health care you need to receive to determine if you are covered by the insurance or program.

• How We Will Contact You
  

  Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. Contacts by mail may be postcard or sealed envelope. If you want to request that we communicate to you in a certain way or at a certain location, please inform us in writing as to the method of communication you wish to receive.

• Appointment Reminders
  

  We may use and disclose medical information about you in order to contact you to remind you of an appointment we have with you.

• Treatment Alternatives
  

  We may use or disclose medical information about you in order to contact you about alternative services that may be of interest to you.

• Health Related Benefits and Services
  

  We may use and disclose medical information about you in order to contact you about health-related benefits and services that may be of interest to you.

• Marketing Communications
  

  All use and disclosure of medical information about you by us to make a communication about a product or service or to encourage the purchase or use of a product or service will be done only with your written authorization.

• Individuals Involved in Your Care
  

  With your written consent, we may disclose to a family member, other relative, a close personal friend, or any other person identified by you in the initial assessment medical information about you that is directly relevant to that person's involvement with your care or payment related to your care. With your written consent, we may also use or disclose medical information about you to notify or assist in notifying those persons of your location, general condition, or death. If there is a specific family member, other relative, or close personal friend to which you do not want us to provide your information, please notify Affordable Home Care Services, Inc. in writing of your request.

• Disaster Relief
  

  With your written consent, we may use or disclose medical information about you to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. This will be done to coordinate with those entities in notifying a family member, other relative, close personal friend, or other person identified by you of your location, general condition, or death.

• Required by Law
  

  We may use or disclose medical information about you when we are required to do so by law.

• Public Health Activities
  

  We may disclose medical information about you for public health activities and purposes when required by law. This includes reporting medical information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease or one who is authorized to receive reports of child abuse and neglect. It also includes reporting for purposes of activities related to the quality, safety, or effectiveness of a United States Food and Drug administration regulated product or activity.

• Victims of Abuse, Neglect, or Domestic Violence
  

  We may disclose medical information about you to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence if we believe you are a victim of abuse, neglect, or domestic violence. This will occur to the extent the disclosure is: (a) required by law; (b) agreed by you; or (c) authorized by law, and we believe the disclosure is necessary to prevent serious harm to you or to other potential victims.

• Health Oversight Activities
  

  We may disclose medical information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licenser, or disciplinary actions.

Right to Amend
You have the right to ask us to amend medical information about you. You have this right for so long as we maintain the medical information (a minimum of two (2) years beyond the last date of service provided). To request an amendment, you must submit your request in writing to Affordable Home Care Services, Inc. Your request must state the amendment desired and provide a reason in support of that amendment. We will act on your request within thirty calendar days after we receive your request. If we grant your request, in whole or in part, we will seek your identification of and agreement to share the amendment with other persons relevant to your care. We will also make the appropriate amendment to the medical information by appending or otherwise providing a link to the amendment.

We may deny your request to amend medical information about you. We may deny your request if it is not in writing and does not provide a reason in support of the amendment. In addition, we may deny your request to amend medical information if we determine that the information:

• Was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment;
• Is not part of the medical information maintained by us;
• Would not be available for you to inspect or copy; or
• Is accurate and complete.

If we deny your request, we will inform you of the basis for the denial. You will have the right to submit a statement disagreeing with our denial. Your statement may not exceed 3,000 words or 10 pages, whichever is less. We may prepare a rebuttal to that statement. Your request for amendment, our denial of the request, your statement of disagreement, if any, and our rebuttal, if any, will then be appended to the medical information involved or otherwise linked to it. All of that will then be included with any subsequent disclosure of the information, or at our election, we may include a summary of any of that information. If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial with any future disclosures of the information. We will include your request for amendment and our denial (or a summary of that information) with any subsequent disclosure of the medical information involved. You also will have the right to complain about our denial of your request.

Complaints
You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. To file a complaint with us, contact Affordable Home Care Services, Inc. All complaints should be submitted in writing. To file a complaint with the United States Secretary of Health and Human Services, send your complaint to him/her in care of: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue S.W. Washington, DC 20201. You will not be retaliated against for filing a complaint.