上述客户(以下简称“客户”)已请求 Asian Choice Inc.协助其准备和/或提交 Medicaid(医疗补助)或其他公共福利项目的申请或续期材料。

客户理解并确认，Asian ChoiceInc,仅提供行政及申请协助服务，不提供法律意见、法律代理或财务建议，也不负责决定任何申请人的资格，亦无权批准或拒绝任何申请。所有资格认定及福利审批均由相关政府机构独立作出。

客户声明并保证，其向 Asian Choice Inc,提供的所有信息及文件均真实、准确、完整，并且据客户所知不存在任何虚假或遗漏。客户理解，如所提供的信息不准确、不完整或具有误导性，可能导致中请处理延迟或影响福利资格。

客户同意，因政府机构作出的决定，或因客户或任何第三方提供的信息不准确、不完整或未及而导致的福利申请被拒绝、延迟、暂停、终止或变更，Asian ChoiceInc.及其所有者、员工和作均不承担任何责任。

在适用法律允许的最大范围内，除因故意不当行为或重大过失且法律禁止免责的情形外，客户除 Asian Choice nc.及其所有者、员工和代表因提供行政协助服务而产生的任何索赔或责任。

客户理解，AsianChoice Inc,仅保留为提供所请求服务所必需的信息。所有个人信息的收集、使和保护将按照适用的隐私法律法规(包括适用情况下的《健康保险流通与责任法案》(HIPAA))行处理。除提供服务及遵守法律或监管要求所必需的期限外，Asian ChoiceInc.不会保留客户的机密资料。

客户在下方签字即表示其已阅读、理解并自愿同意本《服务协议与免责声明》的全部条款。

The above-named client ("Client") has requested assistance from Asian Choice Inc. with the preparation and/or submission of applications or renewals for Medicaid or other public benefit programs.

The Client understands and acknowledges that Asian Choice Inc. provides administrative and application assistance only. Asian Choice inc. does not provide legal advice, legal representation, or financial advice, and does not determine eligibility for or approve or deny any application. All eligibility and benefit decisions are made solely by the appropriate government agency.

The Client certifies that all information and documents provided to Asian Choice inc. are true, accurate, and complete to the best of the Client's knowledge. The Client understands that inaccurate, incomplete, or misleading information may delay processing or affect eligibility for benefits.

The Client agrees that Asian Choice lnc. and its owners, employees, and representatives are not responsible for any denial, delay, suspension, termination, or modification of benefits resulting from decisions made by government agencies or from inaccurate, incomplete, or untimely information

provided by the Client or other third parties To the fullest extent permitted by applicable law, the Client releases and holds harmless Asian Choice inc., its owners, employees, and representatives from claims arising out of the administrative assistance provided, except where prohibited by law or resulting from intention misconduct or gross negligence.

The Client understands that Asian Choice lnc. maintains only the information necessary to provide the requested services. Any collection, use, and protection of personal information will be handled in accordance with applicable privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA), where applicable. Asian Choice inc. does not retain confidential records