Notice of Privacy Practices

Affinity Medical Services Inc is required by law to maintain the privacy of your Protected Health Information (“PHI”), to provide you this Notice of our legal duties and privacy practices, to notify you following a breach of unsecured PHI, and to follow the terms of the Notice currently in effect.

We may use and disclose your PHI, without your separate authorization, for the following purposes:

• Treatment — to provide, coordinate, and manage your durable medical equipment and related care, including sharing information with your physicians and caregivers.
• Payment — to bill and obtain payment from Medicare, Medicaid, and other insurers, including eligibility verification, claims submission, and prior authorization.
• Health care operations — for quality assessment, compliance and audit activities, accreditation, training, and general business management.
• Business associates — to vendors who perform services for us (for example, clearinghouses and storage providers) under written agreements that require them to safeguard your PHI.
• As required or permitted by law — including public health activities, health oversight, law enforcement in limited circumstances, and to avert a serious threat to health or safety.

Other uses and disclosures — including most uses for marketing, and any sale of PHI — will be made only with your written authorization, which you may revoke at any time.

• Right to inspect and copy your PHI in a designated record set.
• Right to request an amendment of PHI you believe is incorrect or incomplete.
• Right to an accounting of certain disclosures we have made.
• Right to request restrictions on certain uses and disclosures.
• Right to request confidential communications by alternative means or at an alternative location.
• Right to a paper copy of this Notice, even if you agreed to receive it electronically.
• Right to be notified following a breach of your unsecured PHI.

To exercise any of these rights, contact our Privacy Officer using the information below.

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any PHI we receive in the future. The current Notice will be posted on this website and available at our office.

Affinity Medical Services Inc — Privacy Officer
9900 13th Ave N, Ste 210H, Plymouth, MN 55441
Phone: 1-800-779-5479
Email: support@affinitymedservices.com