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Notice of Use & Disclosure Practices

This notice describes how clinical information may be used and disclosed, and how you can get access to this information. Please review this notice carefully. 

How we use your health information

Affinity Residential and care will make every effort to protect the privacy of your personal health information. 


Personal Health Information (such as diagnosis, home care services, clinical data, or medications) will be disclosed:

  1. To other health care providers currently providing service to you (e.g. case manager, physician, pharmacist) 

  2. To health care providers who may provide service to you through a referral at your request or at your responsible party’s request (e.g. medical transportation service, equipment supplier) 

  3. To other providers when so requested by you or your responsible party. 

  4. To your insurance or other funding sources as required for reimbursement.

  5. To governmental agencies overseeing home health care.

Only the minimum amount of protected health information necessary to accomplish the purpose of the disclosure or request will be provided. For instance, we will provide information about functional limitations to the transportation provider. Except as required by law, Affinity Residential and care will not release your health records without a signed and dated consent from you.

As a recipient of home care services, you have the right under law to have personal, financial, and medical information kept private, and to be advised of our policies and procedures regarding disclosure of such information. 


You also have the right to be allowed access to records and written information. We will comply with your written request for copies of records or a summary of the information in the records unless such information is detrimental to your physical or mental health or would cause you to harm yourself or another. 


In such a situation, the information can be given to another provider or to your responsible party.   

You have the right to ask us to change personal health information in the clinical record. Please make any such request in writing.  


We will not amend records in the following situations if Affinity Residential and care: 


  1. Does not have the records you want amended,  

  2. Did not create the records you want amended,  

  3. Has determined that the records are accurate and complete or  

  4. The records have been compiled in anticipation of a civil, criminal, or administrative act or proceeding. 


Affinity Residential and care is required by law to maintain the privacy of its clients’ protected health information. 


If you would like further information about the privacy of your protected health information privacy policies, please contact:

Zahnia Harut,

CEO & Administrator

Affinity Residential Care

140 W 98th St

Bloomington, MN 55420


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