At Selfhelp Special Family Home Care Certified Home Health Agency (“Selfhelp”), we appreciate the trust you place in us and we recognize the importance of protecting the confidentiality of your medical record and other health related information. We are required by law to maintain the privacy of your personally identifiable health information collected and maintained as part of your medical record or as part of the services we provide (“Health Information”). We are also required to provide you with this Notice describing our obligations and privacy practices.

I. We Are Permitted To Use and Disclose Health Information About You For Treatment, Payment and Health Care Operations

The law permits Selfhelp to use and disclose Health Information about you without your consent or written authorization when such use or disclosure is necessary to assist us with providing your health care services. We are also allowed to disclose Health Information about you to your insurance company or other responsible payor and to hospitals, physicians, nurses, providers, suppliers or other persons or entities for the provision of health care services.

Examples of the various ways in which we may use or disclose your Health Information for purposes of treatment, payment and health care operations include the following:

For Treatment. We may use and disclose your Health Information when providing you with treatment and services and coordinating your care with other health care providers involved in your care. For example, we may contact your physician to discuss your plan of care. Your Health Information may be used by doctors involved in your care and by nurses and home health aides as well as by physical therapists, pharmacists, medical equipment suppliers or other persons or entities involved in your care.

For Payment. We may use and disclose your Health Information for billing and payment purposes, including disclosing such information to an insurance or managed care company, Medicare, Medicaid, another third party payor or to your authorized personal representative. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for services that will be provided to you.

For Health Care Operations. We may use and disclose your Health Information as necessary for health care operations, such as management, personnel evaluation, education and training and to monitor our quality of care. We may also disclose your Health Information to another entity with which you have or had a relationship if that entity requests the information for its health care operations, quality assurance, care coordination, accreditation, credentialling, licensing or compliance activities. For example, Health Information of many patients may be combined and analyzed for purposes such as evaluating and improving quality of care and planning for services.

II. Specific Uses And Disclosures Of Your Health Information

We are also permitted to use or disclose your Health Information without your consent or written authorization as follows:

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose Health Information about you to a family member, close personal friend or other person you identify, including clergy, who is involved in your care.

Emergencies. We may use or disclose your Health Information as necessary in emergency treatment situations.

As Authorized or Required By Law. We may use or disclose your Health Information when authorized or required by federal, state or local law to do so.

Business Associates. We may disclose your Health Information to a contractor or business associate who needs the information to perform services for Selfhelp. We require that our business associates be committed to preserving the confidentiality of Health Information disclosed to them.

Public Health Activities. We may disclose your Health Information for public health activities, such as reporting to a public health authority to prevent or control disease, injury or disability; reporting child abuse or neglect or reporting births and deaths.

Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your Health Information to notify a government authority, if authorized by law or if you agree to the report.

Health Oversight Activities. We may disclose your Health Information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure actions or for activities involving government oversight of the health care system.

To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information about you when necessary to prevent a serious threat to your health and safety of the public or another person. This type of disclosure would only be to those we believe would be able to help prevent the threat.

Judicial and Administrative Proceedings. We may disclose your Health Information in response to a court or administrative order. We also may disclose your Health Information in response to a subpoena, discovery request, or other lawful order or process.

Law Enforcement. We may disclose your Health Information for certain law enforcement purposes, including, for example, to comply with reporting requirements; to comply with a court order, subpoena, warrant, summons or similar legal process; or to answer certain requests for information concerning crimes. Research. We may use or disclose your Health Information for research purposes if the privacy aspects of the research have been reviewed and approved by Selfhelp.

Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your Health Information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organ donor bank.

Disaster Relief. We may disclose Health Information about you to a disaster relief organization.

Military, Veterans and other Specific Government Functions. If you are a member of the armed forces, we may use and disclose your Health Information as required by military command authorities. We may disclose Health Information for national security purposes or as needed to protect the President of the United States or certain other officials or to conduct certain special investigations.

Workers' Compensation. We may use or disclose your Health Information to comply with laws relating to workers' compensation or similar programs.

Inmates. If you are under the custody of a law enforcement official or a correctional institution, we may disclose your Health Information to the institution or official.

Fundraising Activities. We may use certain limited information to contact you in an effort to raise funds for Selfhelp and its operations.

Appointment Reminders. We may use or disclose Health Information to remind you about appointments. If you have an answering machine we may leave the reminder in a message.

Treatment Alternatives and Health-Related Benefits and Services. We may use or disclose your Health Information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you.

III. Your Rights with Respect to Your Health Information

You and your authorized personal representatives have specific rights with respect to your Health Information, including the right to:

Request restrictions on certain uses and disclosures of your Health Information. (Selfhelp will try to honor your requests, but we are not required to agree to a requested restriction.);

You have the right to ask that we send you information at an alternative address or by an alternative means if you have certified that your request is necessary to prevent a use or disclosure of your Health Information that could endanger you. We will agree to your request as long as it is reasonably easy for us to do so.

You may inspect and copy your Health Information which includes medical records. Please note that in some cases we may be required or permitted to deny access to certain information, such as HIV related information or psychotherapy notes consistent with law, information compiled in connection with a civil, criminal or administrative proceeding, or information subject to laws governing biological products and clinical laboratories. A reasonable copying charge may be imposed for copies of your Health Information.

Amend Health Information. If you feel that Health Information about you is incorrect, you may ask us to amend the record. The request has to be made in writing, and include a description of the reason that supports your request. Selfhelp is not obligated to comply with your request to amend your record.

Receive an accounting of disclosures of Health Information. Please note that we are not required to provide an accounting of the following:

Any Health Information collected prior to April 14, 2003 and information shared for treatment, payment and health care operations purposes;

Information disclosed pursuant to your written authorization;

Information disclosed for national security or intelligence purposes;

Information disclosed to correctional institutions, law enforcement officials or health oversight agencies; or

Information disclosed as part of a limited data set for research, public health or health care operations purposes.

We may require that you submit your requests for an accounting in writing. We will attempt to respond to the requests within 60 days, unless an additional 30 days is required. We will provide you with one free accounting every 12 months. A reasonable fee may be charged for any additional accountings within a 12 month period, and we will tell you in advance how much the accounting will cost so that you have opportunity to withdraw or amend your request;

Revoke authorization to use or disclose medical information, except to the extent that action has already been taken based upon the authorization; and

Obtain a paper copy of this Notice, even if you have agreed to receive notices electronically. You may also view a copy of this notice at our Web site at www.selfhelp.net.

IV. Authorizations For Uses of Health Information Other Than As Specified Above

Except as described in this Notice or permitted by law, Selfhelp will not disclose any of your Health Information without your written authorization. If you provide us with authorization to use or disclose Health Information, you may revoke the authorization at any time by writing to us. If you revoke an authorization, we will no longer use or disclose your Health Information for the purposes covered by the authorization, except where we have already relied on the authorization.

V. Complaints and Inquiries

You may complain to Selfhelp and the Secretary of the U.S. Department of Health and Human Services if you believe that your privacy rights have been violated. There will be no retaliation for filing a complaint. If you wish to file a complaint with Selfhelp you should submit your complaint in writing.

If you wish further information on this Notice of Privacy Practices, please contact us.

VI. Changes in Selfhelp’s Notice of Privacy Practices

Selfhelp is required to abide by the terms of this Notice of Privacy Practices as currently in effect. Selfhelp reserves the right to change the terms of the Notice. Prior to implementing any revised Notice, Selfhelp will provide you with a copy. In addition, Selfhelp will post the revised notice on its Web site, www.selfhelp.net.

The effective date of this Notice is April 14, 2003.