OUR HOUSE, INC.

NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed and how to get access to this information. Please review it carefully.

Understanding what is in your record and how your health information is used helps you to: a) ensure its accuracy, b) better understand who, what, when, where, and why others may access your health information, and c) make more informed decisions when authorizing disclosure to others.

This notice applies to individuals, legal guardians or parents of minor children receiving services from Our House, Inc. as well as to all employees and volunteers of the agency.

Protected Health Information (PHI) excludes individually identifiable health information in education records covered by the Family Educational Rights and Educational Rights and Privacy Act, as amended, 20 U.S.C. 1232g.

Our House, Inc.'s Responsibilities:

• Maintain the privacy of your PHI
• Provide you with a notice as to our legal duties and privacy practices with respect to information Our House, Inc. collects and maintains about you.
• Accommodate reasonable requests you may have to communicate PHI by alternative means or at alternative locations.
• Notify you if we are unable to agree to a requested restriction.

Our House, Inc. reserves the right to change our practices and to make the new provisions effective for all PHI we maintain. Should our privacy practices change, we will provide you with a revised notice.

General Privacy Rule

Our House, Inc. will not use or disclose your PHI without your written authorization, except as described in this notice.

Revoking your Authorization: If you provide us with a written authorization to release your health information, you may revoke that authorization at any time. A revocation must be in writing. A written revocation will not revoke your prior authorizations if we have already released your PHI pursuant to your prior authorization or if your insurance coverage requires your written authorization.

How We May Use Or Disclose Your Health Information Without Your Written Authorization:

• Treatment. We may use your PHI for your treatment. For example, information obtained from medical personnel will be recorded in your record and may be used to determine your diagnosis and/or provide a course of treatment.
• Payment. We may use your PHI to obtain payment for services we provided to you. For example, a bill may be sent to you or a third-party payor. The information accompanying the bill may include information that identifies you, your diagnosis, etc.
• Health care operations. We may use your PHI for regular health operations. For example, medical and/or Our House, Inc.'s Continuous Quality Improvement Committee may use PHI in your health record to assess the care and outcomes in your case.
• Business Associates. There are some services provided in our agency through contact with business associates (i.e. pharmacist, accountants, consultants, attorneys). We may disclose your PHI to our business associates so that they can perform the job we've asked them to do. To protect your PHI, we require that the business associates appropriately safeguard your information.
• Family and Friend Involved in Your Care. If you do not object, we may share your PHI with a family member, relative, or close personal friend who is involved in your care.
• Funeral Director. We may disclose PHI to funeral directors and coroners to carry out their duties consistent with applicable law.
• Food and Drug Administration (FDA). We may disclose to the FDA PHI relative to adverse events with respect to food, supplements, and products and product defects.
• Workers compensation. We may disclose PHI to the extent authorized by, and to the extent necessary to comply with, laws relating to workers compensation or other similar programs established by law.
• Public Health. As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability.
• Law enforcement. We may disclose PHI for law enforcement purposes as required by law or in response to an appropriate subpoena.
• Abuse, Neglect, or Domestic Violence. We may disclose your PHI to the extent provided by law to an authority, social service and/or protective agency if we reasonable believe that you have been a victim of abuse, neglect or domestic violence. We will notify you of this disclosure unless it would place you at risk of serious harm.
• Judicial and Administrative Proceedings. We may disclose your PHI in response to an order of a court or in response to a valid subpoena if we receive satisfactory assurances from the party seeking the information that the party has made an attempt to notify you or to secure a protective order for your information.
• National Security and Intelligence Activities. We may disclose your PHI to authorized federal officials for national security activities.
  

Your Health Information Rights

Although your health record is the physical property of Our House, Inc., the information in your health record belongs to you. You have the following rights:

1. You may request that we not use or disclose your PHI except as required by law for a particular reason related to treatment, payment, the agency's general health care operations, and/or to a particular family member, other relative or close personal friend. We ask that such requests be made in writing to the Privacy Officer. All requests will be considered by the Privacy Officer.

2. You have the right to receive confidential communications of your PHI. If you are dissatisfied with the manner in which or location where you are receiving PHI communications from us, you may request that we provide you with such information by alternative means or at alternate locations. Such a request must be made in writing, and submitted to the privacy officer. We will accommodate all reasonable requests.

3. You may request to inspect and/or obtain copies of PHI about you, which will be provided to you in a timely manner. Such requests must be made in writing to the Privacy Officer. If you request to receive a copy, you may be charged a reasonable fee for the copies.

4. If you believe that any PHI in your record is incorrect or if you believe that information is missing; you may request that we correct the existing information or add the missing information. You must provide a reason to support your request. Such requests must be made in writing to the Privacy Officer.

5. You may request that we provide you with a written accounting of all disclosures made by us of your PHI for up to a six (6) year period of time. However, disclosures made prior to April 14, 2003 do not have to be accounted for by law. We ask that such requests be made in writing to the Privacy Officer. Please note that an accounting will not include the following types of disclosures: a) disclosures made for treatment, payment or health care operations; b) disclosures made to you or your legal representative, or any other individual involved with your care; c) disclosures authorized by you or your legal representative; d) disclosures to correctional institutions or law enforcement officials or for national security purposes; e) disclosures made from the directory; and f) disclosures that are incidental (for example, when information is overheard by another consumer passing by). There is no charge for the first request for an accounting made in any twelve (12) month period, but there may be a reasonable charges for additional requests made in the same twelve (12) month period.

6. You may revoke any authorization to use or disclose your PHI, except to the extent that disclosure has already taken place. Such a request revoking authorization must be made in writing to the Privacy Officer.

For More Information or To Report a Problem

If you have questions and would like additional information, you may contact the Privacy Officer of Our House, Inc. at (908) 464-8008.

If you are concerned that we have violated your privacy rights or you disagree with a decision we made about access to your records, you may contact the Privacy Officer. You may also send a written complaint to the US Department of Health and Human Services. The Privacy Officer can provide you with the appropriate address upon request.